by Eric Martin
Just think, in the rest of the industrialized world, citizens get their fully guaranteed, never rescinded health insurance from the "government" which is always the problem, never the solution. We Americans, on the other hand, get our insurance from the private sector, which means it is, by definition, more efficient and a superior performing product. We know this because government never outperforms the free market. From the incomparable Murray Waas:
In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.
So he hired an attorney — not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.
But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.
By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.
Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
The revelations come at a time when President Barack Obama, in his frantic push to rescue the administration's health care plan, has stepped up his criticism of insurers. The U.S. House of Representatives is expected to vote later this week on an overhaul of the health system, which Obama has said is essential to do away with controversial and unpopular industry practices.
Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.
That point should be emphasized: the current health care legislation would outlaw the practice of rescission - make it illegal for insurance companies to do this under any circumstances (even when there was a pre-existing condition). One obvious retort is that what Fortis did in this case is already illegal, hence Mitchell won his case.
True, but because rescission is currently allowed in a broad set of circumstnaces, insurance companies engage in overly broad sweeps of rescission knowing that either: (a) they have a valid basis for rescission due to a technicality or pre-existing condition; (b) the customer will get discouraged and drop the matter; or (c) the customer will die before there is a resolution of the matter (as with HIV sufferers, they need to locate a source of treatment while the litigation drags on or…they die). Thus, leaving rescission as a viable option creates a nightmare of a health insurance system.
But wait, it gets worse:
"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.
Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."
The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
In affirming the trial verdict and Nettles' order, Toal was as harsh in her criticism of the company as Judge Nettles had been. "We find ample support in the record that Fortis' conduct was reprehensible," she wrote. "Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
Fortis canceled Mitchell's health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company's investigators discovered the note, they ceased further review of Mitchell's records for evidence to the contrary, including the records containing the doctor's diagnosis.
Nettles also suggested that Fortis should have realized the date in the note was incorrect: "Not only did Fortis choose to rely on one false and unreliable snippet of information containing an erroneous date to the exclusion of other information which would have revealed that date to be erroneous, Fortis refused to conduct any further investigation even after it was on notice the evidence which aroused its suspicion to be false," the judge noted.
But surely this is an isolated incident, right?
But state regulators, federal and congressional investigators, and consumer advocates say that in only a tiny percentage of cases of people who have had their health insurance canceled was there a legitimate reason.
A 2007 investigation by a California state regulatory agency, the California Department of Managed Health Care, bore this out. The DMHC randomly selected 90 instances in which Anthem Blue Cross of California, one of WellPoint's largest subsidiaries, canceled the insurance of policy holders after diagnoses with costly or life-threatening illnesses to determine how many were legally justified.
The result: The agency concluded that Anthem Blue Cross lacked legal grounds for canceling policies in every single instance.
"In all 90 files, there was no evidence (that Blue Cross), before rescinding coverage, investigated or established that the applicant's omission/misrepresentation was willful," the DMHC report said.
90 out of 90, huh? Pretty good batting average.
Despite the utterly ridiciluous GOP talking point that the current healthcare legislation represents a "government takeover of health care," in truth all it does is lightly regulate the private health insurance market, and it gives many less well-off Americans subsidies to buy-in to that newly regulated market. Not exactly socialism, and not as good as a real public option, but even then, the GOP is in full histrionics in a desperate effort to defend the status quo.
Do read the rest. If your blood pressure can handle it.
“not record the identities of the persons present”
Did they wear hoods and speak through voice-altering filters?
This sounds suspiciously like a Death Panel. Which is O.K., mind you, because it is a private Death Panel and subject to the profit-seeking rigors of the free market, and, of course, doing so is free speech.
Who sat on this Death Panel? Sarah Death Palin? Erick Death Panel? Mitch McDeath Panel? Steve Velvetglove King of the Death Panel?
Why are they afraid to divulge their involvement in murder?
In other news, Blockbuster Entertainment, a human being by any other name, according to the Supreme Court, was slaughtered like an animal in the marketplace by Netflix.
I’m an accessory to murder.
Thanks for publicizing this.
The case illustrates some of my pet annoyances with those who complain of “frivolous” lawsuits. In their world, the frivolous litigant is always the plaintiff, never the defendant. Yet quite often, it seems to me, the only reason there is a lawsuit is “frivolous” behavior by the defendant, which is to say simple refusal to meet obvious legal obligations until actually forced to do so. One way to deter that is with geneous punitive damages, a too-often reviled aspect of the law.
Another issue, particularly graphic here but much more broadly applicable, is that corporations are immortal, human beings (as distinguished from “persons,” clearly) are not. So all delay works against the plaintiff, who wants to get the whole thing over with and get on with life, while the defendant has no such imperative. Note that it was seven years from the time Mitchell took out his policy to the final decision of the State Supreme Court.
I’d guess Mitchell endured some substantial problems as a result of that delay, while for Fortis lawyers it was just part of the job.
Remember all this the next time you read about some “outrageous” verdict.
is that corporations are immortal, human beings (as distinguished from “persons,” clearly) are not.
What?!!? Damn, I’m going to have to change my plans.
One of the consequences of not regarding healthcare as a public good, and therefore appropriate for regulation (like a utility company), is that this obscene behavior is actually a version of company managers carrying out their fiduciary duties — maximizing profits for shareholders.
The healthcare reform bill on the table is weak in many, many ways. But one thing it does do is initiate the paradigm shift from heathcare being just another commodity to healthcare being a societal concern. We can then build on that in the future.
Predicted people who will be absolutely silent on this topic: Brett Bellmore, blogbudsman, bc
Predicted people who will say, “Hey, he won his lawsuit, so this is a feature, not a bug”: Sebastian, Marty, GoodOleBoy
Predicted person who will simply copy and paste a lengthy cite from a right-wing source with no context or additional commentary: CharlesWT
Predicted people who will predict what other commenters will or won’t say: Phil
This very issue just showed up on TV recently – on the lawyer show The Good Wife – quite a similar story: young couple needing emergency (and expensive) prenatal surgery has their health-insurance policy cancelled for some trivial (but legally permissable) reason. Of course in TV Land, there’s always a work-around: turns out the Big Insurer actually has a corporate division whose only function is to find reasons to cancel [costly]policyholder’s coverage!
What really got me was the facile way in which this practice was presented, in the show, as something vaguely shady, and a pretext for subtle (and fortunately successful) blackmail on behalf of the patient. Stories like Jerome Mitchell’s though, point out that, rather than being some under-the-table impropriety, this is S.O.P. in the Health-Insurance Industry.
IOW, the usual Big-Business dodge: “OUR SLOGAN: There for you
whenuntil you need us!”Actually, it is abug, not a feature that could have been solved at least a year ago if we were focused on the 70% everyone agrees on.
if we were focused on the 70% everyone agrees on.
Everyone? The GOP has voted against similar small-bore measures in the past Marty. I think you’re overly optimistic about the GOP’s willingness to go against the health insurance industry.
And for the record, you need to offset the repeal of rescission with other measures (mandatory buy-ins, other cost control measures). These things don’t work as stand alone measures.
That’s not a prediction. You cheated, Slarti.
Predicted people who will predict what commenters will predict: Slartibartfast and elm.
The first rule of tautology club is the first rule of tautology club.
I tried to cheat, but stupid Typepad wouldn’t let me move my comment upthread of yours.
Stupid, stupid typepad. Ruined a perfectly good joke.
Its been months since snyone disagreed with this. It is not the same as preexisting conditions, which require more cost concern,
As for they don’t work alone, since the current bill kicks in over at least a four year period that argument is a little weak aginst doing it in pieces.
Marty: the 70% everyone agrees on
There’s a line in software circles: everyone agrees that 90% of the features of software products are unnecessary. The problem is, everyone has a different idea which 10% are necessary.
The problem here has been that Republicans refuse to agree among themselves which 70% they would accept. There hasn’t been a counterproposal from the Republicans containing 70% of what’s in the HCR bill with a promise to vote for it. Are the Democrats mind-readers? Are they just supposed to keep presenting random subsets of the bill until Republicans signal their approval? Have you ever tried feeding a kid where they keep telling you they’re hungry but they won’t eat anything you offer, no matter how many different things you try?
Its been months since snyone disagreed with this.
Was it in the GOP legislation? If not, then not so much.
It is not the same as preexisting conditions, which require more cost concern
It’s very much the same, unless you mean to ban rescission except in cases of preexisting conditions. Which would still allow far too much rescission.
In the current example, Mitchell was rescinded because of a pre-existing condition. That’s the point.
Inappropriate recission can be really awful. Which is why it is illegal. It certainly appears that the issue hasn’t been well policed in the past, and that further regulation on it may be needed.
I tend to share Bernard’s concern that often corporations can try to wait it out as one of the key problems with the defendant side of our legal system. (I think that the incentives to name everyone and the kitchen sink as defendants is one of the key problems on the plaintiff side).
But cases like this are great examples of why we should police recission better–I’m not sure there is a compelling reason to try to generalize it to the entire health care debate.
[Just a reminder, before somene accuses me again of wanting to torpedo government health care or other nonsense: My desire for years (as in before Obama was even elected) has been that the uninsured be provided access to Medicare at a deficit neutral rate (ending the stupidity of being forced to rely on your job for health insurance) and as a separate matter providing subsidies to those who can’t afford that rate (so that everyone has access to at least some regularized health care system).]
But cases like this are great examples of why we should police recission better–I’m not sure there is a compelling reason to try to generalize it to the entire health care debate.
The problem is, I think, that as long as you allow rescission, it will be abused because it pays to abuse. If you read the piece, you saw that some insurance co’s made hundreds of millions annually through rescission.
Further, as I said in the post, sometimes the insurance company has a valid reason to rescind (either on a technicality of improper application, or for a previous condition). Neither of those seem like particularly ethical moves to defend when it comes to health insurance IMHO.
Just to be that guy…
There is recission and there is recission. I mean, there are reasons for which coverage should be recinded (material misrepresentation, emphasis on material). It’s just that those instances are, presumably, incredibly rare. It is obvious that the practice is being abused and needs to be regulated.
I’m glad that the reform bill will deal with this. Does *anyone* disagree with that? I can’t imagine that even a GOP congresscritter would publicly admit to opposing regulating recission…
… this obscene behavior is actually a version of company managers carrying out their fiduciary duties — maximizing profits for shareholders.
Even if there were no shareholders demanding maximal profits; even if there were no C-level executives demanding fat paychecks; there would still be a “fiduciary duty” — to the customers.
No, not the sick or petentially sick customers. The healthy customers. The ones who pay the premium every month but do NOT have medical costs. How can you keep their premiums low if you don’t take care to exclude sick people from your customer pool?
A health insurance company makes money by collecting premiums from healthy people. The only way an insurance company can “compete” against other insurance companies is to seek out healthier customers than its competitors have. A truly competitive insurance company will find a way to charge the lowest premiums in the business by virtue of insuring only the healthiest customers in the country.
That’s how competition in The Free Market works: if your beloved private-sector health insurer keeps collecting your premiums, that must mean you’re healthy! No wonder people love their private health insurance so much that they defend it tooth and nail against Marxist Fascism. When you’ve got your health, you’ve got everything, right?
–TP
Right Tony. Which is why for-profit health insurance creates such perverse incentives that end up leaving people in need out in the cold.
The mandates to purchase insurance mitigates the costs to insurance companies of not having recourse to rescission any more.
Marty: Actually, it is abug, not a feature that could have been solved at least a year ago
Why would you think this needs “solving”, Marty? Aren’t you an enthusiastic supporter of the free market making US health care superior?
Why, yes, you are!
Well, this is the free market in action making US healthcare what it is, Marty. This is how profit unchecked – the naked free market – works.
And yet, somehow, you don’t seem to like the actual real life examples of what you were so enthusiastically defending in principle so recently. Would that be because you had never actualy thought through what your ideal “free market” is actually like?
See, this is the advantage of basing an argument on facts. You have to look the facts up. Sometimes you learn new stuff. Sometimes when you learn more about what you have been defending, you quit defending it… without making a rather public fool of yourself by defending the free market in healthcare in one thread, and next week claiming the free market in healthcare is a “bug” that should be “fixed”.
Tra-la.
Sebastian: My desire for years (as in before Obama was even elected) has been that the uninsured be provided access to Medicare at a deficit neutral rate (ending the stupidity of being forced to rely on your job for health insurance) and as a separate matter providing subsidies to those who can’t afford that rate (so that everyone has access to at least some regularized health care system).]
So what you desire is a bureaucratic, means-tested version of the NHS… while presumably, like any good conservative, rejecting the idea of the NHS itself.
Which means what you desire is bureaucracy and means-testing. Why’s that? What is it about bureaucracy/means-testing that has made it desirable to you for so many years?
“Well, this is the free market in action making US healthcare what it is, Marty. This is how profit unchecked – the naked free market – works.”
Exactly. A couple of decades from now I can see what healthcare has become being taught as an instructive example of the free market doing what it is programmed to do. Free marketeers often chime in at this point that, since we don’t have a truly free market (damn government) in healthcare it’s never been given a chance. Such folks tend to be big fans of the Gilded Age.
“A truly competitive insurance company will find a way to charge the lowest premiums in the business by virtue of insuring only the healthiest customers in the country.”
Essentially you think that adverse selection is a large problem in the US health insurance case.
But studies indicate that it is at most a very small problem. See here
So you are talking about a problem which, while it exists, does not actually have a large magnitude.
Sebastian,
Would you please explain to me how exactly health insurance companies DO compete with each other in a free market?
For the sake of this particular argument, feel free to assume that private insurance companies are good-faith actors: they really are trying to provide a service to their customers.
That service has two parts: risk pooling and cost averaging. Risk pooling means that some customers pay more in premiums than they ever receive in medical reimbursements. Cost averaging means that every customer gets to pay for the “average” customer’s medical costs steadily over time rather than in big lumps as needed.
These are simple financial service functions. Simple enough that we can assume all competitors will be equally efficient at fullfilling them. Whatever “creativity” gets promoted by “competition” in a free market must take some other form than simple good-faith actuarial calculation.
Okay, WHAT form?
–TP
So, under the new regime, if it passes, claims won’t be denied? Ever? People will get whatever they want, when they want it, no questions asked? And for less money too? Awesome. I can’t wait.
Here are a couple of thoughts: first, you can’t statutorily eliminate chickenshit, whether its government chickenshit (not an unknown happenstance) or private party chickenshit. It’s just there. The question is: what’s remedy for the consumer when told “no”?
In the private party context, the remedy is to go to court. I don’t know what SC law is, but here in the People’s Republic of Texas, health insurers who deny, wrongly, a claim for benefits pay an automatic 18% annual penalty plus attorney’s fees and are further exposed to an additional penalty up to three times actual damages (also in addition to attorneys fees). Admittedly, the judicial remedy is a distant second to timely treatment, but my question is: what will the remedy be under HCR? Or, under a single payer system, in countries with that program?
Further to Sebastian’s point, taking a hard look at limiting rescission make sense. It’s finite and manageable.
So, under the new regime, if it passes, claims won’t be denied? Ever? People will get whatever they want, when they want it, no questions asked? And for less money too? Awesome. I can’t wait.
Um, what? Claims will be denied if the procedure is not covered. But HIV meds? No, those won’t be denied.
And for less money? Most likely, since the bill mandates that insurance co’s spend 80-85 percent of dollars collected from customers on care. The current ratio is quite different.
Admittedly, the judicial remedy is a distant second to timely treatment, but my question is: what will the remedy be under HCR? Or, under a single payer system, in countries with that program?
See, the thing is, we already have government insurance programs – pretty ambitious ones in Medicare, Medicaid and SChip.
The judicial remedies are typical, but generally speaking, the litigation is less numerous. Rescission is not about insurance companies saying: “We don’t cover facelifts” and then getting sued. Rescission is when someone contracts an expensive illness, and then the insurance company searches for ways to purge them from the rolls.
That doesn’t happen with government insurance. So less lawsuits about getting purged from the rolls.
Chicken’s defecating or not.
Tony P–my sense of how private insurers compete is that they enter into provider agreements keyed off of a percentage of Medicare. The lower the provider reimbursement rate, the lower the premium (or, the higher the profit margin). Some insurers offer Provider List A (high end docs and high end hospitals) at one premium level and lesser providers at lower levels. The punch line is that you get what you pay for, subject always to the above-mentioned chickenshit factor.
Um, what? Claims will be denied if the procedure is not covered. But HIV meds? No, those won’t be denied.
So, does the current bill spell out what is covered and what isn’t? Whether I can get treated appropriately–operative word appropriately–is a pretty big concern. I suspect it does not. I also have the feeling that ‘bending the cost curve’ is going to reduce what is covered to the revenue available to pay for whatever coverage is then afforded.
So, does the current bill spell out what is covered and what isn’t?
No, the insurance policies do.
Whether I can get treated appropriately–operative word appropriately–is a pretty big concern.
This is the same concern as private insurance holders have currently.
Remember, this is still private insurance.
I also have the feeling that ‘bending the cost curve’ is going to reduce what is covered to the revenue available to pay for whatever coverage is then afforded.
Is this feeling based on anything of substance that we can debate in an empirical way? Or should I add what my “feelings” are?
… here in the People’s Republic of Texas, health insurers who deny, wrongly, a claim for benefits pay an automatic 18% annual penalty …
Eighteen percent of what? The medical reimbursement they wrongfully denied? I’m just curious.
… but my question is: what will the remedy be under HCR? …
What would you like it to be? No matter what entity you have a contract with, your ultimate remedy for breach of that contract is a lawsuit. Lawsuits are a pain in the ass. But I’m sure you can think of even worse ways to deal with chiselers, just like I can.
–TP
McKinneyTexas: So, under the new regime, if it passes, claims won’t be denied? Ever? People will get whatever they want, when they want it, no questions asked? And for less money too? Awesome. I can’t wait.
Well, in that case, move to the UK, and you won’t HAVE to wait!
(Questions asked, of course: but only medically appropriate ones to make sure you get the health care you need.)
If you need help or advice about moving to the UK, since you “can’t wait”, the UK Borders Agency has a useful website here. Oops, wrong URL – it’s here. Let me know when you get here and I’ll buy you a drink.
McKinney,
my sense of how private insurers compete is that they enter into provider agreements keyed off of a percentage of Medicare. The lower the provider reimbursement rate, the lower the premium (or, the higher the profit margin).
I think this is an important aspect of the insurance business. But note what this means. The biggest insurers in an area are able to negotiate the lowest rates from hospitals and other providers. So it becomes difficult for smaller insurers to compete, and you end up with very few choices. (see here)
So there’s not really significant competition in many areas, and you get monopoly results – higher than optimal prices, less-than optimal supply.
“Is this feeling based on anything of substance that we can debate in an empirical way? Or should I add what my “feelings” are?”
So shall we discuss the empirics of adverse selection? Or shall we continue talking about it as if it were an enormous problem in the health insurance industry despite the evidence to the contrary?
Unfair reccision isn’t pretty and it isn’t right, but reccission AT ALL isn’t the norm. A huge majority of people with cancer or AIDS or other hard to treat illness get covered. If you want to crack down on recission cheating, I’m all for it. But that doesn’t make it a good stand in for most of the problems that plauge our health systems. And it is mostly irrelevant to the question of whether or not a general overhaul (or even one particular ill) is great idea.
I don’t have a problem with saying the recission is bad. I have a problem with the direction of the conversation to link it to everything else without a better examination of what links you are asserting.
If you are asserting it as an exemplar of the general precept of adverse selection as a major problem in health insurance, you’re going against the evidence.
It is a great emotional appeal (Like the Walter Reed hosptial disaster area is for the anti-government health care argument). But like Walter Reed, focusing quite a bit on it doesn’t actually answer useful general questions about government/private health care.
In the current example, Mitchell was rescinded because of a pre-existing condition.
It looks to me like Mitchell was rescinded because of a new condition. Once that happened, what made it impossible for him to get insurance anywhere else was his preexisting condition.
Sebastian: Or shall we continue talking about it as if it were an enormous problem in the health insurance industry despite the evidence to the contrary?
Your position, then, is that given only a small percentage of people die each year because of rescission, those deaths cannot constitute an “enormous problem” and we shouldn’t talk about them? I’m fairly sure this represents a change of heart from last year…
Jesurgislac:
Nope. As is often the case you are overdrawing conclusions.
And as is also often the case you are dragging in abortion for no apparent reason.
We can talk about the problem of inappropriate recission. We can try to fix it. That doesn’t mean that it automatically gives you an “I’m right on everything” card. Not even on the topic of health care.
Thanks.
Sebastian, your choice of Walter Reed was unfortunate for your argument, as it was intentionally left to rot by the previous administration (perhaps it was hoped that this world-renowned medical facility would be taken for exactly the government failure you claim, once it had crumbled enough).
Emotional appeal is not enough, on either side. Make your argument, if you’ve got one.
Chmood, you’re going to have to be more specific. I’m not aware of any executive order to destroy Walter Reed. Or anything even remotely like that.
I made my argument. Inappropriate recission is bad. We should correct it. The issue of recission, at least as presented here, has very little to do with the overall health care debate. As a stand in for adverse selection in general it is a bad proxy (more anecdote than data).
The wiki article on the Walter Reed scandal (or the salon article about it) is typical. Walter Reed was largely about ridiculous and disengaged bureaucracy. One of the key problem administrators, Kussman, was a problem there as far back as the 1990s (i.e. predating Bush).
It is used as a symbol of bureaucratic incompetence in government institutions. Which may or may not shed light on how government runs health care in general any more than recission does on insurance in general.
Once the court verdict was upheld, the penalty should have been siezure of all assets and instant corporate death wiping out shareholders and bond holders alike. Let them go sue the agents (corporate executives and the board members).
The funds would be put into escrow for the benefit of the policy holders.
Conservatives like to draw bright (but intellectually shallow) moral lines (crime, abortion, war, etc.). Let’s see how they would deal with this one.
Some years back I got a high-deductible individual insurance policy through Fortis. I suspected at the time that it was essentially useless, because if I developed any really expensive problem they’d go through my long, long application with a fine-tooth comb and no doubt find something they could call a misrepresentation. Looks like I was right.
I have yet to see anything that would give me confidence that under our current system individual insurance is likely to be honored when it’s really needed.
Eric,
How is the House or Senate Bill any better than the status quo in this regard?
Fortis tried to cancel Mitchel’s policy on the grounds he had misrepresented his condition (which he hadn’t.) They used, as pretext, a nurse’s note in his medical records which suggested, erroneously, that Mitchell knew he was HIV+ before he bought the policy. In other words, they used the fraud loophole, which the HCB Bill allows to stand. Misrepresentation will still be a material breach of contract, even if insurers can’t deny or terminate claims for pre-existing conditions.
Unless HHS has the authority to pre-approve insurer termination of contracts for “fraud,” the only way to challenge rescission will be in the courts, just like it is now.
Sebastian: That doesn’t mean that it automatically gives you an “I’m right on everything” card. Not even on the topic of health care.
Except that Jes *is* right on health care Sebastian, and everyone in the developed world outside the US knows it. Here in the People’s Republic of Australia, you get what you need, medically, paid for by what we call Medicare, whatever age you are. It costs less money per head. We have better life expectancy and general health. You can get private health insurance if you like paying health insurance. And no conservative party here would *dare* try to repeal it.
No one can even understand why the USA is so weird in this area. It’s utterly baffling.
How is the House or Senate Bill any better than the status quo in this regard?
If I’m not mistaken, pre-conditions do not bar you from getting insurance (you may have to pay more, but you can get insurance). Also, since recision for non-fradulent reasons are barred, the burden of proof switches more toward the insurance company.
These two things alone make a lot of difference.
Gwangung,
I don’t think that’s what the bill says. Unless you are suggesting there is a mechanism for vetting insurer rescission, the burden remains on the insured in case of termination of policy to show that it was unwarranted.
The case Waas writes of has nothing to do with whether pre-existing conditions are covered or not. It has to do with the way the insured represented his medical condition. The insurer claimed (falsely) that Mitchell knew he was HIV+ before he bought his policy, but did not tell the insurer. If Mitchell *had* misrepresented his condition, even if Fortis was required by law to cover him, it would still have been a breach of contract. It’s common practice, as Eric notes, for insurers to scour medical records looking for some un-crossed T or un-dotted I that would give them plausible denial against malice in a court case.
The question is, what does the Bill the House will vote on Sunday do to disincentivize insurers from rescinding policies on flimsy pretexts like this? If rescission is still allowed in cases of fraud, and insurers are allowed to make determinations of fraud without oversight, this kind of practice is going to continue unabated.
I asked Sebastian: Would you please explain to me how exactly health insurance companies DO compete with each other in a free market?
McKinneyTexas offered this reply: Tony P–my sense of how private insurers compete is that they enter into provider agreements keyed off of a percentage of Medicare. The lower the provider reimbursement rate, the lower the premium (or, the higher the profit margin). Some insurers offer Provider List A (high end docs and high end hospitals) at one premium level and lesser providers at lower levels. The punch line is that you get what you pay for, subject always to the above-mentioned chickenshit factor.
Bernie commented on the first piece of that: I think this is an important aspect of the insurance business. But note what this means. The biggest insurers in an area are able to negotiate the lowest rates from hospitals and other providers. So it becomes difficult for smaller insurers to compete, and you end up with very few choices.
Bernie is of course correct that McKinney’s picture of competition implies a positive-feedback loop: the more market share an insurer has, the better able it is to gain more market share. “Competition” leads to monopoly.
Now, just to show how fair-and-balanced I am, let me defend McKinney against Bernie. Here’s what limits the feedback loop. The potential market includes all the people in the relevant area — from the chronically ill to the hale and hearty. To “gain market share” means to insure more people. If you have already insured most of the healthy people, gaining market share means insuring more and more sickly ones. That means you can’t keep your premiums as low as they used to be. So a scrappy competitor can come along and steal some of your healthier customers.
Oh sure, your competitor (being smaller) has to offer doctors reimbursement rates that are a bit higher than yours. But he has room to do that, and not just because (being scrappy) he’s willing to take a smaller profit than you are. He is going after your healthiest customers, remember? You were offering them nice low premiums when they were the only customers you were insuring — but you had to raise their premiums once you pooled them together with sicker people in your drive for market share. Your competitor can offer them lower premiums than you’re charging them now, even if those have to be slightly higher than you were offering them before.
Naturally, you (the big insurer) will counter this gambit. You will drop your premiums for your healthy customers, and raise them for your sicker ones. If you are really clever, you will fine-tune your premiums to the point where every customer is paying exactly and only his own actuarially-expected medical costs.
That seems fair, but it also seems like something less than insurance.
So I think we still need a better answer than McKinney offered. If “competition” leads to monopoly, why bother with competition? If “competition” leads to ever-finer subdivisions of the risk pool, why bother with insurance?
Incidentally, the second part of McKinney’s comment reminds me of an old George Carlin joke: if there’s a best doctor in the world, there has to be a worst doctor in the world — and somebody has an appointment with him tomorrow. Somebody who got a great deal on “health insurance”, no doubt.
–TP
The problem for you is, Tony, that in reality, there doesn’t seem to really be much adverse selection.
So me trying to figure out a way around it isn’t necessary. I’m just describing it empirically. You seem to essentially be saying that according to your theory of how it all works, there must be adverse selection. Then you insist that the burden is on me to show that you are wrong.
Empirically there doesn’t seem to be much adverse selection.
I’m not sure what else I need to offer.
Emma, could you look up the thread and find what I think US health care should look like? I think you impression of what I think and what I actually think are rather different.
Hint: 2:22 P.M.
Thanks.
Are you ever going to actually answer Tony’s question about how insurers compete, Sebastian, or simply keep telling him he’s wrong about something he didn’t ask about?
And as is also often the case you are dragging in abortion for no apparent reason.
Oh, that’s rich.
Does Fortis accept the sentence or will it appeal to SCOTUS? I would not bet any money on SCOTUS upholding it and be not at all surprised, if there’d be another 5-4 pro-coprorate decision. I see even a remote possibility that this could be another Citizen United with the ‘totally non-activist, strict constructionist’ faction declaring all of HCR unconstitutional in passing. In that case I propose to rename the court SCUMTUS.
“Did they wear hoods and speak through voice-altering filters?”
I vote for holographic icons around an empty table, rather like the meetings in Evangelion.
In my flavor of libertarianism, requiring companies to actually comply with their contractual commitments is a good thing. I might think we’d be better off if we could find a way to do that without involving government, but this is clearly an area where government is doing something appropriate.
Or in this case, not doing it, and you might ask how that happened, before assuming the government would be better if you cut out the private middle man.
Chris Schoen, if there is no longer an exclusion for preexisting conditions, then what sort of fraud would you be committing by omitting one from your application? I’d expect application forms to be drastically simplified, since there’s no point in wasting time and paper on things that are irrelevant to coverage.
My understanding is that gwangung is wrong, and they can’t even charge more for preexisting conditions. They can charge more for age and possibly for smoking, but those are different from preexisting conditions.
In my flavor of libertarianism, requiring companies to actually comply with their contractual commitments is a good thing. I might think we’d be better off if we could find a way to do that without involving government,
Yeah, arbitration usually works out pretty well. If you’re the corporation.
It looks to me like Mitchell was rescinded because of a new condition.
On the pretense that it was, in fact, a pre-existing condition. That was not disclosed.
The question is, what does the Bill the House will vote on Sunday do to disincentivize insurers from rescinding policies on flimsy pretexts like this? If rescission is still allowed in cases of fraud, and insurers are allowed to make determinations of fraud without oversight, this kind of practice is going to continue unabated.
Legally speaking, which I’m sure you know Chris, “fraud” is only “fraud” if the person lying stands to gain financially from it/or the other person being defrauded is injured. Failing to disclose a pre-existing condition would cause no harm because it wouldn’t change the terms of the insurance under the new bill, hence, no fraud.
Breach of contract is not fraud. Breach of contract would be failing to dot an “i” or cross a “t” – but such reasons are no longer recognized as justifying rescission.
It is my understanding that the fraud exception has more to do with double billing and other forms of theft. After all, what sense would it make to outlaw denial for pre-existing condition, and outloaw charging more for pre-existing conditions, but allow an insurance company to rescind for failure to identify a pre-existing condition on ground that this was “fraud” even though there was no injury.
Unless you have exact text in the bill, or a link to analysis of the same. Otherwise, that is not my understanding of the changes.
‘In my flavor of libertarianism, requiring companies to actually comply with their contractual commitments is a good thing.’
Not much mention anywhere I can find of any presence of an insurance regulator in this South Carolina case, or any oversight of the behavior of the legal staff of the insurance company for that matter. In the case of the investigation of Anthem Blue Cross in California, statistics were cited (meriting serious punitive action) but there was no indication of such action by the insurance regulator.
The jury and the court in South Carolina seemed to have little difficulty deciding how this behavior should be treated. I don’t have knowledge of the insurance regulatory environment in the state, but it seems non-existent. No mention that the plaintiff’s hired legal advisors had interaction with state regulators. Same for California. Are there no insurance regulators? Maybe there should be. If there are regulators, is this the behavior we should expect from our state government employees? Do we have a reason to believe our federal employees will do better?
‘Once the court verdict was upheld, the penalty should have been siezure of all assets and instant corporate death wiping out shareholders and bond holders alike.’
After proving a pattern of such behavior, I like this action. But how about some specific criminal actions against the legal advisors who were clearing the path?
After proving a pattern of such behavior, I like this action. But how about some specific criminal actions against the legal advisors who were clearing the path?
I’m fine with all of the above.
If there are regulators, is this the behavior we should expect from our state government employees? Do we have a reason to believe our federal employees will do better?
Yes, they won’t have the incentives to cheat customers. See, ie, Medicare and Medicaid.
Not much mention anywhere I can find of any presence of an insurance regulator in this South Carolina case, or any oversight of the behavior of the legal staff of the insurance company for that matter.
Well, after gutting regulation during the 80s up to the present, now conservatives want to cap lawsuit awards too.
Europre is less litigious, but it has regulations with teeth. Those are the choices: either use lawsuits to compel good behavior, or use government regulations.
Modern conservatives, of course, opt for neither. Just let the businesses regulate themselves! No conflict of interest there.
Sebastian: As is often the case you are overdrawing conclusions.
I live in a country where, for sixty-plus years, there has been no such thing as rescission: which delivers superior health care to the US: which costs less.
You defend the practice of withdrawing health insurance from some people because it’s “appropriate” to make them go without health care and the small percentage of people who die because of inappropriate rescission is just not a big enough problem to talk about.
You have consistently and persistently argued the exact reverse with regard to late-term abortion – that it’s a big enough problem no matter how small the percentage of late-term abortions.
So apparently, fetuses dying “inappropriately” is a big problem worth talking about and justifying withdrawing full health care from women.
But once a fetus has been born – baby, child, adolescent, adult – their death due to withdrawal of health insurance is not a big problem, and not worth talking about.
It would appear that the only consistency between your two positions is that it’s appropriate to withdraw health care – either from women seeking abortions, or from anyone whom the insurance company can claim lied on their application form.
The problem of substandard and more-expensive health care for women (according to what I have read, women pay more for health insurance in the US than men do, even though insurance companies are entitled to refuse to cover contraception, childbirth, and abortion costs) is a big part of the problem in the US, and a big part of the reason the US has the highest infant death rate in the developed world.
Pro-lifers tend to oppose universal health care. This is surprising only to people who take seriously their claims that their support for denying women access to safe legal abortion is all about “saving babies”. If those claims were true, that ought to make pro-lifers the most fervent and consistent supporters of universal healthcare in the US.
But of course – the exact reverse is generally true.
Wow. BB and GOB actually managed to defy my expectations, by looking for a way to blame the government, rather than the guilty party, for the situation described in Eric’s post. Bravo, maestros!
‘Well, after gutting regulation during the 80s up to the present, now conservatives want to cap lawsuit awards too.’
Does this response mean that neither the S.C. or Ca. insurance commissioner had the necessary authority to take action against abuses?
Regarding the earlier points made about competition, the one thing I view as important is to have a choice of providers. Although government, utilities, and other monopoly providers frequently, even mostly, do a good job, whenever this is not the case, inability to go somewhere else is a great frustration. And it’s a nightmare to appeal a process to the same party that is causing the issue in the first place.
‘Wow. BB and GOB actually managed to defy my expectations, by looking for a way to blame the government, rather than the guilty party’
I’ll accept credit for blaming the government, but not for not blaming the guilty party.
Does this response mean that neither the S.C. or Ca. insurance commissioner had the necessary authority to take action against abuses?
It means that neither had direct oversight, and secondary regulatory powers are extremely limited. The fruit of “small government” Republicans and libertarians that view regulation as evil.
Another upside of the HCR bill is that the government can boot providers that engage in bad conduct from the pools.
Taunter had a post on the high likelihood of facing rescission if you fall in the 99th percentile of premium holders, which is where most of the money is being spent. Rescission is applied to about 0.5% of all policies a year, yet vast majority of money paid out by insurance companies (22% of costs, $35,000 or more per policy) all come at the the top 1%. Considering rescission saves hardly any money below the 99th percentile, if rescission is being applied to that 1% of policy holders, then there’s a 1 in 2 chance of those individuals to have their insurance “rescinded”.
In fact, Mitchell is the perfect example of a target; young, with a chronic, manageable disease that will cost the insurance company hundreds of thousands over his (extendable-with-treatment) lifetime.
Eric,
I just read the actual bill and answered my own question. Insurers can’t rescind until there has been a “third party, independent review.” That’s good enough for me.
I’m curious to see if the insurers will come up with a type of material misrepresentation that isn’t based on underwriting. But as long as they can’t terminate the contracts unilaterally, I think the protection in the bill is a good one.
“Wow. BB and GOB actually managed to defy my expectations, by looking for a way to blame the government, rather than the guilty party, for the situation described in Eric’s post. Bravo, maestros!”
You actually managed to get pissy at the suggestion that regulators should force insurers to pay out benefits, because it came from the “wrong” side. Bravo, Phil!
I’m shocked, SHOCKED, that a regulator in SC might not really stand up for the little guy. SHOCKED!
“You have consistently and persistently argued the exact reverse with regard to late-term abortion – that it’s a big enough problem no matter how small the percentage of late-term abortions.”
Indeed I have. But I quite specifically DO NOT argue that the problems associated with late term abortions make me automatically right about everything else, even in the abortion debate. I specifically DO NOT argue for example that the fact that women sometimes seek what is essentially infanticide in late term abortions for no health reason whatsoever (which you have for years denied, and yet you so helpfully linked a case of in Utah) logically implies that early term abortions should be banned.
[This is not an invitation to derail the thread by talking about when you think abortion is or is not appropriate]
“But once a fetus has been born – baby, child, adolescent, adult – their death due to withdrawal of health insurance is not a big problem, and not worth talking about.”
Getting from my view as expressed on this thread and elsewhere to the conclusion you draw is purely emotional trolling. I have not once suggested that inappropriate revocation of policies is “not worth talking about”. I have stated that it is a bad thing but that correcting it doesn’t justify all the arguments being used about health care in general.
A similar argument would be saying that terrorism is a bad thing, but that ‘fighting terrorism’ does not justify invading Iraq or shredding civil liberties at home.
Do you truly not understand that kind of distinction?
Brett, are you seriously going to try that one on me after your recent jihad against the ACLU just because they don’t support gun rights? Really?
Because I’m feeling charitable, though, I’ll give you a head start towards the actual point:
The problem isn’t with regulators forcing insurers to pay out benefits; the problem is with a health care system that’s reliant almost entirely on insurers who have to be forced by regulators or courts to pay out benefits, rather than simply honoring their obligations.
But if it makes you feel better to pat yourself on the back for recognizing that a corporation actually did something bad and that government might be able to help, well, buy yourself a box of Thin Mints and put it on my tab.
“if rescission is being applied to that 1% of policy holders, then there’s a 1 in 2 chance of those individuals to have their insurance “rescinded”.”
That is a mighty big ‘if’ and that ‘if’ is not shown anywhere by your quote. And while anecdote isn’t usually data, when you are claiming a 50% chance, you invite the following:
I am personal friends with about 40 people who are HIV+. About half of them have private insurance. About half of them are advanced enough to require fairly expensive annual care. None of them have been rescinded.
Now all of them are super careful not to let the insurance lapse because they know that applying for new insurance will be difficult. Which is an important issue worth talking about (which I have addressed upthread as well). But none of them have been rescinded, and I think none have even been investigated for it. Additionally I have a friend who discovered she had breast cancer under a private policy–not revoked or even investigated for revokation and my sister had a serious problem which I won’t reveal the nature of, but who also was not revoked or investigated.
And so out of a sample of 22 or 12, depending on how you serious you think the condition has to currently be, the posited 50% chance shows zero instances.
Sebastian, could you summarize what your actual point is?
I’m kind of lost here. You say rescission doesn’t happen enough to matter. But it definitely happens, you don’t disagree with that, the consequences are bad, you don’t disagree with that, and the bill addresses it. So… what are you getting at? We shouldn’t talk about iniquities of the current system that are resolved by the legislation we support unless they meet your criteria for occurrence?
Seriously, plenty of people here are clearly willing to listen to what you have to say, but speaking for myself, I have no idea what you’re getting at. This is a problem, it is a small part of the motivation for the bill, it is resolved by the bill. What is it that you’re trying to say about it?
Sebastian,
As Phil pointed out to you, my original question was “how DO insurers compete with each other?”
You say my “theory” implies that they do it by “adverse selection”, which is not emipirically observed. Leaving aside whether “adverse selection” (sicker people choosing to buy insurance, when they can) is the same thing as “cherry-picking” (companies choosing healthier customers, when they can), we are still left with the question: how DO insurers “compete”?
When you tell us that all of your 12 or 22 friends are “are super careful not to let the insurance lapse because they know that applying for new insurance will be difficult”, I cannot possibly read that as evidence that insurers are in any sense competing for their business.
My question is sincere, believe it or not. I am fully prepared to accept an answer like “okay, they DON’T compete, so quit bugging me.” I am fully prepared to accept an explanation, alas not yet presented, of how they DO compete. An answer like “well they MUST be competing because ‘adverse selection’ is at worst a small problem” is evidence of a kind, but it’s not an explanation.
–TP
It seems to me that they compete on things like co-payments, annual deductibles and doctor selection options.
It seems to me that they compete on things like co-payments, annual deductibles and doctor selection options.
Do they? (This is an invitation to show examples across the US, of two insurance companies operating in the same part of the US, who are competing financially by offering different systems of co-payments and annual deductibles.)
If so, the first two options are purely financial, and given that most people in the US get insurance via their employers (yes?) this would suggest this is employers picking the health insurance company that can offer them the cheapest rates for covering their employees – which will not necessarily mean the best coverage for their employees.
The third option, “doctor selection options”, presumably means that some health insurance companies will be trying to offer something like the freedom of choice we have in the UK by virtue of a national insurance system? This would be actually beneficial to the patients, but as the patients will not (for the most part) get to choose their health insurer, their employer will, it’s hard to see how this would help an insurance company “compete”.
(If none of your disparaging comments in the thread prior to mine were intended to discourage debate on the practice of recission, that’s certainly how they came across, Sebastian: but I take your word for it you had no such intention.)
Jesurgislac, your examples are Kaiser, HealthNet and BlueShield. All in California.
Which I know, because just this last month I have been shopping for an individual plan. In California.
“Brett, are you seriously going to try that one on me after your recent jihad against the ACLU just because they don’t support gun rights? Really?”
Yeah, Phil, I’m seriously going to point out to you that you got mad at me for agreeing that insurers shouldn’t cheat their customers. And that it’s OK for governments to enforce contracts.
I might wish that there were better non-governmental options for accomplishing this, but, hey, if you’re going to have a government, it might as well be doing something useful, and enforcing contracts IS useful.
Sebastian,
I’m not quite sure the paper you linked to supports the “adverse selection is minor” claim so clearly. Maybe it does, but I have some doubts.
I was unable to locate a free copy, so just had to read the abstract, in itself a poor substitute in most cases.
Lots of “modestly,” and “somewhat,” and “considerable,” here, but no numbers. Aparently there are some effects, so there is some tendency for insurers to reject those with health problems in unregulated states. That presumnly is what is meant by “competing through adverse selection” in this discussion.
And it is sort of hard to believe that insurers ask applicants to fill out forms with medical histories and then ignore the information.
Are there other studies of which you’re aware on this topic, or do you know of a free version of this paper?
Seb, we might be getting down to brass tacks here. I hardly expect you to go into specifics about your personal insurance shopping, but I would be grateful to hear in general terms how you — a prospective customer — get competed for.
I can imagine, for instance, that Kaiser, HealthNet, and BlueShield each offer you several different plans. Each company, I bet, has both a higher-deductible/lower-premium plan and a lower-deductible/higher-premium plan. Each of them, in other words, offers you the choice to keep more risk for yourself, or pay them to take some risk off your hands. One of them will have the plan which (along this particular dimension, anyway) you judge to be the most “competitive”.
So, is that one benefit you get from competition between insurers? That one of them makes a better guess at your personal taste for risk than its competitors do?
And if so, do you think it’s because its actuaries are smarter, or dumber, than the actuaries of its competitors?
–TP
Sebastian: Jesurgislac, your examples are Kaiser, HealthNet and BlueShield. All in California.
That’s not “examples”, Sebastian: that’s names. You claim they offer competing versions of health insurance. What, exactly, are they competing on?
Brett, who besides you said I was mad at anyone? You really need to adjust your Karnakometer. It leads you in the wrong direction nearly every time.
“That’s not “examples”, Sebastian: that’s names. You claim they offer competing versions of health insurance. What, exactly, are they competing on?”
Ummm, let’s go to the film:
Sebastian: “It seems to me that they compete on things like co-payments, annual deductibles and doctor selection options.”
Jesurgislac: “Do they? (This is an invitation to show examples across the US, of two insurance companies operating in the same part of the US, who are competing financially by offering different systems of co-payments and annual deductibles.)”
Sebastian: “Jesurgislac, your examples are Kaiser, HealthNet and BlueShield. All in California.”
Jesurgislac: “That’s not “examples”, Sebastian: that’s names. You claim they offer competing versions of health insurance. What, exactly, are they competing on?”
To which I will reply: “things like co-payments, annual deductibles and doctor selection options.”
Apparently offering “how” and the “names” in two separate comments when one was a direct response to your question about the first was confusing to you. Now they are both in the same comment. We can only hope that will be less confusing.
Tony–they each had a high deductible and low deductible plan, but the definition of high and low was fairly different in two of the three cases (I don’t remember which one was which now, but for two the high deductible was either too low to make a big enough premium difference for me, or WAY too high). All of them had very different choices about doctors and health plans that were ‘in network’, and that shaped my choice as well. (Though I eliminated plans that flatly didn’t cover or put an enormous premium on going out of network which is one of the main reasons I didn’t go with Kaiser). Most of the Blue Cross/Shield Plans high deductible plans also had high percentage co-payments. This didn’t fit my needs as I’m using it as true insurance–i.e. I expect to pay nearly all regular medical needs out of pocket in any given year; i’m paying to be covered for the truly unexpected cases.
So yes, on the surface, all the companies offer high/low and low/high programs. But they aren’t that similar in actual details about how high and low and what comes with it.
I don’t know about the individual market, but the group plan market certainly has a fair amount of variety & competition here in California. My wife got her benefits at her last job through an HR outsourcing firm so there were maybe a dozen different plans with differing levels of employee contribution, co-pays, and coverage. We opted for the most expensive, quite sensibly, since the employer pays the larger share anyway and the difference in employee contribution was going to be a wash with the co-pays. Which is also a clue that the “competition” isn’t very important. All the plans cover catastrophic conditions and to the extent they vary it’s in minor things that roughly wash out in the difference in premiums. But yes, there is competition.
The problem isn’t competition if you don’t have major healthcare needs, it’s that if you really truly need healthcare to deal with a chronic health problem, you just can’t get it in the individual market. Flat out, can’t get it. And if you can’t get a job (perhaps because of that chronic health problem…) but you’re not poor enough for Medicaid, you’re screwed – or more likely, you’re screwed for an extended period until you become poor enough for Medicaid – which I do not think is very economically or socially efficient. This is not a hypothetical concern, it happens all the time. I agree rescission is a fairly small problem (but very serious when it occurs), but it’s a symptom of an individual market for insurance that just does not work at all for cost-spreading.
“The problem isn’t competition if you don’t have major healthcare needs, it’s that if you really truly need healthcare to deal with a chronic health problem, you just can’t get it in the individual market.”
I think you’re saying “health care” where you mean “insurance”. Because you darned well can get “health care” in the individual market. You just walk in, and pay for it.
Now, you can’t get insurance for a chronic condition, that’s cheaper than just paying for the treatment out of pocket, that much is true. That’s because the actuarial calculation, “cost of treatment” x “probability of needing it” makes insurance silly for chronic conditions.
Might as well complain that you can’t get auto insurance that pays for your gasoline…
Sebastian: For some reason, you seemed to find it easier to give the information I’d asked for (twice) to Tony rather than to me, but whatever: he asked for it too, and you’ve had less arguments with him about your active support for diminished healthcare for women. So.
Most of the Blue Cross/Shield Plans high deductible plans also had high percentage co-payments. This didn’t fit my needs as I’m using it as true insurance–i.e. I expect to pay nearly all regular medical needs out of pocket in any given year; i’m paying to be covered for the truly unexpected cases.
But your definition of “health insurance” brought up an interesting point: if your insurance does not cover your regular medical needs, you – a middle-class professional, reasonably well-off – seem to take for granted a far lower standard of health insurance than we have in the UK. After all, regular medical needs are normally necessary to keep a person in good health – and what is the point of a healthcare system that doesn’t keep people in good health?
And you, Jes, are also confusing “health care” and “insurance”; I expect Sebastian is probably getting his regular medical needs met: He’s going to the doc for regular checkups, and paying for it directly, rather than through his insurance.
“Health care system” does not equal “insurance”. Insurance is merely one of many ways of paying for health care, and a way which only makes sense under a certain limited set of circumstances. When the expenses are perfectly predictable is not among those circumstances.
Yes. This is a very good argument for some sort of national (dare I say socialized) health insurance system. Or was that not your intent?
Well, we don’t respond to the fact that some people can’t afford to feed themselves, by mandating that groceries sell food at a loss, do we? We have food stamps.
But why national? And why insist on calling it “insurance”?
Here’s what I would do:
1. Change the tax laws, so that privately purchased health insurance has the same tax status as health insurance purchased for you by your employer. This helps with the biggest problem today, the fact that, when you change employers, you have to change insurers. That’s the biggest source of “preexisting conditions”.
2. Change the law so that people can buy insurance across state lines, so that the market is less of an oligopoly.
3. STRINGENT regulation of insurers, aimed at making sure they actually deliver on the benefits they’ve contracted to deliver. With serious penalties for frivolous recision.
4. State level programs of “health insurance” and “health care” stamps, to enable the poor to afford to buy them. As I say, we don’t respond to people who can’t afford to feed themselves by mandating that groceries and restaurants sell them food below cost, why should we do that to insurance companies and doctors? If it’s really for the general welfare, it should show up on the general budget, not be palmed off on the private sector by regulation.
I see a systematic problem with the Democratic proposals: You take a system which has perverse incentives, add some more perverse incentives, and then order people not to respond to those incentives! That doesn’t really work very well, guys. People respond to incentives regardless of what the law says.
Well, we don’t respond to the fact that some people can’t afford to feed themselves, by mandating that groceries sell food at a loss, do we?
The US government does subsidise the production of some foods quite heavily, making them extremely cheap to buy.
As I say, we don’t respond to people who can’t afford to feed themselves by mandating that groceries and restaurants sell them food below cost
Actually, it would save the US a lot of money if, instead of subsidising corn and other grains and meat so that people on a low income can easily afford to buy cheap meat and cheap processed food full of starch and corn syrup, the US government instead subsidised the production of organic vegetables, fruit, and other wholesome, healthy food, so that people on a low income could more easily afford to eat healthily and found it more expensive to eat unhealthily.
It also saves a lot of money when, instead of having health services and health insurance required to make a profit, you have a national health insurance programme which everyone pays for and everyone benefits from, free at point of use.
But you know. It’s not as if conservatives/libertarians care about saving taxpayer’s money when it’s being spent on corporate welfare rather than to benefit the general public…
People with chronic conditions still need “insurance” per se because the costs of treatment for chronic conditions can be very variable above the baseline cost of treatment. And of course because having one chronic medical condition is no guarantee against getting sick in some other way.
So yes, you still need insurance even if you have a chronic condition.
Why national? Look around you – do you see it being done at the state level? It needs to get done, I don’t care who does it. Is it really that much of a problem to do it at the federal level and not the state level? If they’d included a state-by-state opt-out I wouldn’t have really cared, but what’s the real problem here?
I agree that the differing tax treatments and the employer-tied nature of the insurance are problems, but bear in mind, it is not only the tax advantage that makes employer-based healthcare desirable; it’s also the risk pooling, which you lose when you go to individual coverage. Now this bill definitely is a push in that direction with the exchanges and so on – clearly separating health insurance from employers is part of the plan (since it’s happening anyway). But then we have to get right back into community rating and must-issue regulations, which leads straight back down the rabbit hole – to prevent adverse selection death spirals, you need mandates & subsidies.
At which point you pretty much have the HCR bill on the table. Which has “health insurance stamps” – that is, subsidies to buy private health insurance.
There is no mandate in the bill on healthcare providers to provide health services below cost.
Those who support the direction of the current health care reform efforts led by the progressive democrats seem not to understand or care about the concept of ‘choice’ and it’s importance to those who value this aspect of individual liberty, guaranteed to to each American in the Constitution. Having a ‘choice’ means that I should be able to choose what medical care I acquire, when, where, and from whom, as well as how I will pay for it. It also means individuals may choose careers in various health care related professions without terms of earning a livelihood being dictated by bureaucrats. As many as one-third of physicians surveyed recently indicated they will consider leaving the profession if the pending legislation passes. Any legislation that reduces or eliminates the ability of individuals to exercise these choices as described is unamerican. Nothing in this comment suggests that individuals who want to join with others, cooperating voluntarily and freely, to deliver health care as a group, should be inhibited from doing so as long as there is no compulsion of others. There is also no suggestion here that those who are not able to provide for their own health care should not receive government assistance.
“There is no mandate in the bill on healthcare providers to provide health services below cost.”
Yeah, right. When you mandate that insurers take on people with preexisting conditions, you’re not going to mind one bit somebody getting hit with a $100,000 per year premium, just because that’s how much their preexisting condition costs to treat. That’s just going to pass without comment.
“Why national? Look around you – do you see it being done at the state level?”
Massachusetts? Anyway, the fact that the level of government that’s supposed to be doing things outside of a short list of activities, isn’t doing one you want, is no reason to demand it of the level of government which is constitutionally subject to enumerated powers.
You want to do it at the federal level, because you figure that elected state governments which chose not to do it, won’t have any choice in the matter. I don’t think that’s a legitimate reason to do something at the federal level.
No, I want to do it at the federal level because that’s the only level it’s going to get done at. MA stands alone in providing universal health insurance. That sucks.
The federal government is constitutionally subject to enumerated powers, yes, one of which is to provide for the general welfare, so that argument isn’t going to get very much traction.
As for your $100,000 premium, group-pool health insurance provides for cost spreading and risk pooling. Which is why when we had our baby we didn’t get a bump to $50,000 in premiums for that year, and when I was a hale 20-something I didn’t get a discount for never going to the doctor. That system works extremely well for employer-provided group-pool insurance and there is no reason to think it won’t work for universal insurance. And no provider nor health insurer will be required to provide services below cost. You don’t like it because it smacks of socialism. Well, it is socialism. Employer-provided healthcare and government-provided healthcare is socialism on a small and restricted scale, and in that context, it works. We want to expand the context marginally to cover the 10% of the population not presently covered by said socialist healthcare systems. It’s kind of a long way from here to the gulags.
As many as one-third of physicians surveyed recently indicated they will consider leaving the profession if the pending legislation passes.
This is actually not true:
http://mediamatters.org/blog/201003170036
More conservative misinformation to fool a suspecting public.
Having a ‘choice’ means that I should be able to choose what medical care I acquire, when, where, and from whom, as well as how I will pay for it.
Which is good that the current health care legislation doesn’t change that at all. It doesn’t tell you what medical care you acquire, when, where or from whom you can get it. You can also pay in any number of ways.
There is also no suggestion here that those who are not able to provide for their own health care should not receive government assistance.
Which is what this bill does!
Any legislation that reduces or eliminates the ability of individuals to exercise these choices as described is unamerican.
Um, OK. But the bill doesn’t do that.
Eric, I know the bill does not do those things you pointed out. But I view this bill as the first step on the road to serfdom,the first step in an effort to have the government take over one-sixth of our economic activity. I see a recent step in the education finance area is already in the works. And immigration waiting in the wings. Freedom depends on this being stopped here and now.
Brett has described a pretty fair formula for dealing with some of the major issues in health care. But I realize that progressives really want to have welfare without the government payments looking like welfare and the way to do that is to reduce everyone to the same low level but equal service and pretend this is some sort of democracy since it yields equality of outcome, in theory at least. This is basic to communism. What comes after health care? Education? Energy?
We likely will know after tomorrow what the next steps will be. If the bill is not stopped, there will be challenges under constitutionally required congressional procedures to make law or under the tenth amendment . That should be fun. Then, of course, all House members must face voters in November.
“Which is what this bill does!”
Which is one of the multitude of things this bill “does”. and it is not even clear it does this by definition since there are still many people not covered.
At the end of the day, hours before the final vote, I find the evolution of the discussion remarkably depressing.
The clear focus of this legislation for liberals and progressives, notably one of the easiest things for me to agree with them on, was to provide at least baseline coverage for everyone.
Fail.
The second was to focus on lowering costs of health care delivery.
Fail.
Now this is a bill to expand coverage to some(not all) and regulate insurance companies. For a trillion dollars plus it seems like a pretty big fail.
Which is one of the multitude of things this bill “does”. and it is not even clear it does this by definition since there are still many people not covered.
Right. But the critics of the bill from the right want to cover even less! The Dems were pushing for universal coverage, and they pared it back because of GOP resistance/centrist Dem resistance.
The clear focus of this legislation for liberals and progressives, notably one of the easiest things for me to agree with them on, was to provide at least baseline coverage for everyone.
Tell me about it. But to get that, we need more and better Democrats. We need to get more Russ Feingolds and less Republicans and Liebermans and Nelsons.
I mean, the GOP plan cost more, covered fewer people and didn’t cut delivery costs one iota.
The second was to focus on lowering costs of health care delivery.
But it does lower costs. This just isn’t true. And, again, it could have further lowered costs if the public option or single payer were adopted. But the right opposed.
For a trillion dollars plus it seems like a pretty big fail.
First of all, it’s less than a trillion. Second, it reduces the deficit due to cost cutting, taxes and spending cuts. And it could have been even cheaper if a public option or single payer were adopted.
Eric, I know the bill does not do those things you pointed out. But I view this bill as the first step on the road to serfdom,the first step in an effort to have the government take over one-sixth of our economic activity.
Couple of thoughts: other than the UK, few Western nations have actually pursued taking over health care. On the contrary, most preserve private health care systems with a guaranteed public insurance, with private insurance supplementals.
Not a bad deal really.
As for serfdom, this was the warning for Western Europe issued so many years ago. And yet…quality of life is in many ways better than it is in America. And either way, NOT remotely close to serfdom.
But I realize that progressives really want to have welfare without the government payments looking like welfare and the way to do that is to reduce everyone to the same low level but equal service and pretend this is some sort of democracy since it yields equality of outcome, in theory at least. This is basic to communism.
No, that is basic BS. This is nowhere to be found on the American political landscape. It’s fantasy borne out of paranoia.
But it does lower costs. This just isn’t true. And, again, it could have further lowered costs if the public option or single payer were adopted. But the right opposed.
No it doesn’t lower the cost of delivery, and neither would the puyblic option. This is still talking about paymet, not delivery.
First of all, it’s less than a trillion. Second, it reduces the deficit due to cost cutting, taxes and spending cuts. And it could have been even cheaper if a public option or single payer were adopted.
It costs more than a trillion dollars and it isn’t even deficit neutral (refer to Seb’s nice explanations of gaming the system). And they don’t even have a CBO report yet to prove the games worked, they keep touting an unreleased preliminary CBO estimate, which is really weak.
Most of all, the steady decline of expectations keeps getting blamed on Republicans, when every change in the bill for the worse was driven by Democrats.
Oh I like the way the current talking point is Reps/centrist Dems because it is just too hard to admit that the bill isn’t good by any standard but we have to pass it for purely political reasons.
Or we can admit the process failed to craete anything that was good and continue to work on it, with a more measured approach. Get the recission/preexisting conditions fixed, cover the uninsured with Medicare baseline expansion and then focus on cost of delivery.
But no, we have to do it all now (whatever all turns out to be) or “it will be decades before anything is done”. This defines the lack of will to do something good or right.
Seb,
Thanks for the rundown. It does seem like the three insurance companies are offering you different tranches of the same risk, namely your “unexpected” medical costs in a given year, at different prices. I have no doubt that you can price your own risk better than their actuaries can. You probably do save a few bucks (actuarially speaking) by having the choice.
Now put yourself in the shoes of those 12 to 22 friends you talked about before. You didn’t say they all live in California, but let’s pretend they do. The same “system” that saves you a few bucks through “competition” between insurers requires them to be “super careful not to let the insurance lapse because they know that applying for new insurance will be difficult”. Do you see any connection at all between their “difficulty” and your “choice”? Does “competition” between insurance companies have anything to do with it?
Jes,
Rest assured that if I have given Seb less grief over abortion than you have it’s only because I don’t trust myself to do so as temperately as you do.
Jacob,
The only thing I quibble with in your 10:18 comment is the proposition that “it’s also the risk pooling, which you lose when you go to individual coverage”. From an insurer’s point of view, its individual customers are by definition a “pool”. Competition is what makes the insurer try to keep sick people out of its pool. Competition is what makes the insurer try to subdivide its pool down to individual-sized puddles so that Seb doesn’t have to share his particular puddle with his 12 to 22 friends.
Brett,
You are correct that health insurance is merely one way to pay for health care. Insurance is a financial service, not a medical one.
And I’m with you on the proposition that it’s idiotic to tie health insurance to employment. Thankfully, us libruls did manage to loosen that tie a bit in 1965 — over the vociforous opposition of consrvatives, mind you. Retired people are not “employed”. But they do have health insurance.
You say that insurance is a fine way to pay for health care in some circumstances but “when the expenses are perfectly predictable is not among those circumstances.” This begs several questions. Let me start with this one: when do expenses become “predictable”?
GOB,
When you write “Having a ‘choice’ means that I should be able to choose what medical care I acquire”, I assume first that you mean “require” and second that you mean “I” very literally. If I’m not mistaken, you’re not too hot on letting other people (e.g. pregnant women) have a ‘choice’. It’s nice that you love your own freedom, but it’s not particularly praiseworthy. Saddam Hussein loved his own freedom, too. The measure of your love of freedom is how much you value your neighbor’s freedom. You can accuse a commie pinko librul like me of falling short in that regard, but I don’t pretend to be quite the freedom-lover you profess to be.
–TP
I have one more idea that doesn’t ever seem to get talked about, it is my primary criticism of insurance companies. The whole pool concept is absurd. The pool should consist of everyone that an insurance company insures. Then insurance companies would truly compete on price and availability of providers to attract the lowest risk people to offset the higher risk policies.
And, just to add one more important way that insurance companies compete, it is important to evaluate the breadth of provider acceptance. When we purchase insurance for the company the key measures are cost of a baseline, cost and coverage of a more expensive buy up option (including total potential out of pocket expenses, and provider breadth. Then we look at customer satisfaction for our current and competitive plans to see if the price difference supports the hassle factor.
Most important though is we could save a lot of money if the stupid pool concept was expanded to just include everyone they cover.
Good Ole Boy: As many as one-third of physicians surveyed recently indicated they will consider leaving the profession if the pending legislation passes.
Don’t panic. Similiar scaremongering was going on in the UK from the right-wing press about the establishment of the NHS in 1948.
Didn’t happen. Most doctors have more attachment to their profession than to leave just because they’d be required to provide healthcare to more people, whatever right-wing pundits think…
Oh I like the way the current talking point is Reps/centrist Dems because it is just too hard to admit that the bill isn’t good by any standard but we have to pass it for purely political reasons.
Talking point? Dude, where have you been the past year? Were you paying attention at all to the debate?
Since when were the Republicans talking about covering more people? Since when were the Republicans backing a public option and/or single payer? How can you call observing these obvious facts a new talking point?
Bizarre.
Or we can admit the process failed to craete anything that was good and continue to work on it, with a more measured approach.
So, the more measured approach will cover more people and lower costs more? Hmmm.
Regardless, the GOP will filibuster any bill, and now that the Dems only have 59 in the Senate, this is their only shot. Sucks, but such is the nature of the GOP.
As you pointed out several times with your graph, since they lost the Senate, there has been an enormous spike in the use of the filibuster.
Get the recission/preexisting conditions fixed
How can they afford to do that without a mandate? If you just outlaw rescission/preexisting conditions bans, people will just wait until they are sick, then buy insurance. This won’t work. Need mandates to increase the pool, spread the risk and mitigate the costs.
cover the uninsured with Medicare baseline expansion
That was one of the Democrats proposals!
It was shot down by the centrist Dems and the GOP. Honestly, I wonder if you were paying attention at at all.
It costs more than a trillion dollars and it isn’t even deficit neutral (refer to Seb’s nice explanations of gaming the system). And they don’t even have a CBO report yet to prove the games worked, they keep touting an unreleased preliminary CBO estimate, which is really weak.
No, it does not cost more than a trillion, but rather circa 900 billion. I saw Seb’s arguments, but I’ve seen arguments that challenge his. Ezra Klein:
According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time.
Then you said:
No it doesn’t lower the cost of delivery
But it does. Not only does it begin the process of modernizing record keeping – which will yield big savings – it does this, from Klein again:
The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume.
Also, the promotion of living will consultations will help to lower costs related to our insance end of life care system.
Those who support the direction of the current health care reform efforts led by the progressive democrats seem not to understand or care about the concept of ‘choice’ and it’s importance to those who value this aspect of individual liberty,
STRAW MAN STOPPED READING HERE.
You keep quoting Klein like I am supposed to think he is an expert, do you believe he has any knowledge base beyond public knowledge? He is just an op-ed guy for chrissakes, I don’t even think his opinions are well thought out for the most part, but he ceratinly isn’t an authoritative source.
Unless of course you think sullivan citing klein and klein citing chait and chait half agreeing with douthat and all of them occasionally citing sullivan makes them authoritative, or even more than a circle …oh well.
The savings from record keeping is already underway, this bill won’t do much for it due to the technical and operations challenges in implementing it. (One thing that the public option would have added was a stick to implement common EHR systems interfaces.)
And, btw, I have been here all along. The Democrats couldn’t pass a bill because the Democrats couldn’t pass a bill, because what they are trying to do is not the best thing and too many Democrats know it.
One more thing, if any of the numbers/talking points by Dems is true then covering people with preexisting conditions and stopping recission is should be almost a non event. Those people drive up the cost of health care delivery sunstantially by being treated only on an emergency basis they drive costs by orders of magnitude. So the cost of covering andd treating them should wash. Not to mention we are talking a reasonably small percentage of people in general. So all of this “providing coverage without a mandate” FUD doesn’t wash.
Marty [on Klein]: do you believe he has any knowledge base beyond public knowledge
The fact that information is in the public sphere does not mean you have read and understood it, talked to experts about what it really means, spent many working days studying it, published analysis on it and had it criticized, etc. I certainly haven’t, and I doubt you have either. Ezra has – to say that he is just another op-ed guy strongly implies that you haven’t read him very often – and therefore his opinions & his fact-based analysis do carry a certain weight. We could provide a second-rate paraphrasing and re-hash, or we could link & quote him.
The mere fact that you are working from public information does not imply that all opinions are created equal. Ezra tends to provide strong factual backing for what he has to say.
JD,
Translate, I think he is smart. But he has no information or expertise that makes him an authority.
Ok.
Marty,
Ezra has long studied the issue of health care in America. It is his area of expertise due to the constant focus and scholarship dedicated by him to the topic. It is basically what got him hired at his various media outlets.
He is well regarded by people that study the issue. His reputation is very solid on this topic.
One thing that the public option would have added was a stick to implement common EHR systems interfaces.)
Agreed. Shame there are zero republicans and not enough Dem Senators willing to back the public option – at least not enough to beat a GOP filibuster. Though maybe not even 50.
And, btw, I have been here all along. The Democrats couldn’t pass a bill because the Democrats couldn’t pass a bill, because what they are trying to do is not the best thing and too many Democrats know it.
But it looks like they will pass a bill.
Your complaint is that the current bill is not good. So saying that they won’t pass this bill because Dems don’t like it doesn’t make sense.
The problem is, too many centrists demanded that the bill be watered down so that it is less effective than a bill with a robust public option or Medicare buy-in would be. And since no Republicans would support any such alternative, they had to rely on the centrists (Nelson, Lieberman, Landrieu, Lincoln, Bayh)
But, if you were really paying attention you would know that some Dems have been introducing amendments and proposing bills with public option and medicare buy-in features all along (even as recently as yesterday), but that these bills/amendments keep getting shot down by the so-called centrists – and of course, zero Republican support. Actually the threat of a unified GOP filibuster.
Bottom line, to repeat: The problem is that zero Republicans and not enough Dems (thanks to the so-called “centrists”) would back a Medicare buy in or other form of public option.
Full stop.
If you’ve been paying attention, you would know that. It hasn’t exactly been kept a secret.
‘STRAW MAN STOPPED READING HERE.’
Substitute for BIGOT which doesn’t work well here.
Eric,
I suspect that Ezra has been hired as a blogger because he writes well and is reasonably informed. I suspect if I were to quote George Will as an authority it would be considered questionable.
As for the rest, it is simply disingenuous to keep going back to zero Republicans. The very concept of a trillion dollar complete reform of healthcare is against their fundamental view. In essence expecting them to vote for any bill like this is asking them to become Democrats.
When the Dems weren’t sure about Franken they started the process in the Finance, when they got Franken that process became completely for show.
There was never any expectation, or reason to expect, that Republicans would vote for a bill because they included a few Republican ideas.
The Democrats have the bill they have because the other things that were on the table were not supported by enough Democrats.
I am disappointed because I really thought they would restructure the bill so that it was more limited and targeted so a few Republicans could vote for it, (which I am sure Russell will remind me).
I suspect that Ezra has been hired as a blogger because he writes well and is reasonably informed. I suspect if I were to quote George Will as an authority it would be considered questionable.
No, seriously, Ezra studied this issue in school. It’s his area of focus. I’m not simply stating this as a baseless assertion. He is considered a health care wonk by people in the field. Seriously.
If you quoted George Will as an authority on the history of baseball – an area he has studied – it would not be questionable.
I am disappointed because I really thought they would restructure the bill so that it was more limited and targeted so a few Republicans could vote for it, (which I am sure Russell will remind me).
More limited? Weren’t you just complaining that it didn’t cover enough people, or reduce costs enough? But then you want it smaller, and less cost-saving.
Covering everyone by expanding a Medicare baseline would have been more targeted, cover more people and might have gotten a few Republican votes, if that was all that happened.
Oh yeah, and the appropriate cuts or taxes just to pay for that. Seems that every solution,idea,etc had to be in this bill. We lost the universal and, admittedly my best guess, are spending a lot more on new bureaucracy with less value.
Marty, if the pool consists of everybody the insurer insures, and everybody in the pool pays the same rate, then the insurer is given an incentive to purge their pool of everybody who predictably will cost more than average. See, this is part of what I mean by giving people perverse incentives, and then ordering them not to respond to them.
A pool should consist of those people the insurer has a basis to believe have the same risks. If each such group is priced appropriately, the insurer has no motive to find some way to get rid of some of it’s customers.
A pool should consist of those people the insurer has a basis to believe have the same risks.
See earlier comments about how predictably pro-lifers oppose universal health care, just as they particularly oppose health care specifically for women. Ho hum.
Covering everyone by expanding a Medicare baseline would have been more targeted, cover more people and might have gotten a few Republican votes, if that was all that happened.
The Republican’s strategy is to deny Obama and the Democrats any victories at all. It’s why they’ve been using the filibuster more than it’s ever been used in history (even if the MSM never has the guts to call it that.) It doesn’t matter what the health care proposal might have been — it would meet with the same scorched-earth opposition.
No Brett, the perverse incentives come when you don’t understand that insurance is based on spreading risk across a large enough pool that the lower risk insured all pay a little more to pay for the higher risks to pay less. The incentive you describe goes away when it is illegal to subpool, especially strictly by contract size. There is no reason why a company of 200 should pay more than a company of 2000 or that the pool of individual policies should not be in that same pool.
.
This all forgets that the way insurance companies make money is on investing premiums so they make money on the money, supposedly.
STRAW MAN STOPPED READING HERE.’
Substitute for BIGOT which doesn’t work well here.
Well, no, “straw man” means “straw man,” unless you really want to defend your proposition that a class of commenters as well-educated and experienced as those at Obsidian Wings don’t understand the concept of “choice.”
Tell you what, though, since you’re so married to this concept like a dog with a bone: Find your nearest residential neighborhood, choose to drive 60mph down the street, and then choose to blow through a couple stop signs. When you get pulled over, given a field sobriety test, and possibly cuffed, tell the arresting officer how important “choice” is to you. Let us all know what happens.
“No Brett, the perverse incentives come when you don’t understand that insurance is based on spreading risk across a large enough pool that the lower risk insured all pay a little more to pay for the higher risks to pay less.”
No, I understand insurance: It’s a way of taking a 1% risk of a $10,000 expense, and turning it into a predictable $100 expense you can budget for each year. You want a large enough pool to even out the statistical variations from year to year, but it’s got NOTHING to do with roping in people who aren’t subject to the same risks. The problem here is that you want to combine insurance and a welfare program, but you don’t want to have to pay for the welfare program out of the government’s budget. YOu want to stick insurers with the cost, by compelling them to charge the same premiums to people who are known to belong to different risk groups. Just like my analogy of requiring grocers to sell food at a loss to the poor, instead of having a food stamp program that shows on the budget.
And the moment you do that, you give the insurer a motive to find SOME way of purging their customer base of people with higher risks. Just like forcing auto insurers to ‘ignore’ local variations in claims rates resulted in redlining. Like I said, you want to give people bad incentives, and then ORDER them not to respond to them.
Covering everyone by expanding a Medicare baseline would have been more targeted, cover more people and might have gotten a few Republican votes, if that was all that happened.
Marty, which Republicans? You don’t seem to have paid attention to what the Republicans were demanding/willing to support and it was most definitely NOT an expansion of Medicare.
That might feel good to say for someone such as yourself who seems reasonable enough but can’t square that with Republican instransigence, and yet, that is what it was. Like Mike S said: they were not going to let Obama get a victory on this.
Besides, how would you have increased Medicare baselines? Using what criteria.
Brett, to be clear, it is not imsurance if there is never a loss. That is a bank.
To be clear, it’s also not insurance if you’re subsidizing one identifiable group at the expense of another. It’s welfare.
Well, if you want a welfare program, defend it as such, and let the government pay for it out of general revenues. Don’t pretend that it’s not welfare, and that it’s cost free, just because you’re using regulations to stick some company somewhere with the cost.
No the problem you have is you confuse risk with actuality. Just because someone has an existing illness doesn’t take them out of the risk pool of people who could get the illness.
There are so many things wrong with what is euphemistically called Heath Care Reform, it’s hard to know where to begin.
Let’s start with the Constitution: under what clause, amendment etc. is requiring every citizen to purchase a federally regulated product authorized?
Leaving the Constitution aside, under what concept of individual liberty does mandating the purchase of any product fall? Or federally capping what a private citizen can charge for his/her services?
Economics: the preliminary CBO scoring is predicated on any number of false/highly doubtful assumptions, at least two of which are a 22% reduction in physician reimbursements and substantial compliance with the mandate (I don’t know what the assumed percentage of compliance is, but it has to be damned high to get this program to save money). What are the chances of congress actually cutting physician reimbursements at all, much less by this amount? Nil or less is the answer. More to the point, what evidence is there that physicians will accept patients at such ridiculously low reimbursement rates? Fairy tale land.
As for forcing compliance with the mandate, we’ll just have to wait and see how truly unwieldy and ultimately ineffective that mechanism turns out to be.
Right now, what we have is a huge range of variables, everyone of which has to go as planned, for this deal to even remotely succeed. And we are expected to take comfort that all will work out, based pretty much on assurances from people who (1) do not and never have practiced medicine, (2) have little or no knowledge of day to day claims assessment, payment, etc. (3) know nothing about the actual, out of pocket cost of providing state of the art medical care (4) for the most part have a faith in government that cannot be justified on government’s past performance and (5) who are so naive that they believe that people will actually go along with these mandates.
As an aside, here is how ridiculous the debate has become: Eric cites Ezra Klein as authority for the efficacy of the proposed system. Ezra’s qualifications: he’s been to school and thinks a lot and reads a lot about the subject. Left out is the Ezra is philosophically wedded to the program, so we have a huge issue of bias tilting his analysis.
Bias is only the beginning: instituting a systemic overhaul of this magnitude by people who, by and large, have never run a large company, have never successfully managed a health insurance company and who are essentially theorists ought to be, on its face, an obvious recipe for disaster. Instead, we have the Eric Martin’s and Ezra Klein’s of the world blithely assuring us that, just trust us, it will all work out just fine. We won’t tank the economy, it’s just a light touch, it’s still a private sector operation (sure, with federal mandates ranging from defined premiums, defined services, allowable overhead and no choice as to who your customers are–private sector at its finest, no doubt).
Imagine having an entirely new commercial airliner designed and built from scratch by undergraduate engineers based solely on computer projections and simulations and loading it with passengers for its first flight. No incremental subpart/component testing, no prototype, no prior, similar models as a baseline. Just build the damn thing and put it in the air. HCR is that commercial airliner times multiple orders of magnitude.
Then, there is just the sleeze it’s taken to get this thing done. If a private citizen used his/her own funds to buy the vote of a sitting senator, that would be a felony. If elected officials use taxpayer funds to bribe other elected officials, that’s just good clean fun. And we are supposed to trust and believe that these same people will somehow clean up their act and do a better job in the future than they have up to now? Based on what fricking evidence do we make that leap of faith?
This is a train wreck. It is not some incremental experiment that can be tweaked and adjusted and shelved if it doesn’t pan out. It is virtually irreversible. Our economy, in the long run, will be unable to sustain this burden. Even today, entitlement spending is predicted to swamp the budget in the mid term. Compounding the problem by no one knows to what degree is beyond irresponsible.
One thing that the public option would have added was a stick to implement common EHR systems interfaces.
While I thoroughly support there being common EHR interfaces, this is a massively complicated undertaking that I’m not convinced the public option would actually have helped. The problem in a nutshell isn’t that vendors don’t want a common interface — which the public option would address — it’s that the technical issues involved in creating such an interface are close-to-insurmountable — something the public option wouldn’t address.
[Unless, of course, the public option also required uniformization of data, which I haven’t heard previously and would oppose.]
And a couple more things: is universal health care a right or an entitlement? Either way, it’s a passing strange right/entitlement since it is mandatory, can’t be waived and unlike every other right or entitlement in this country, is subject to a penalty for failing to accept it.
Conceptually, what the Democrats are proposing is not a right, at least not in the sense of every other right we, as citizens, have. Government does not meter out, define, grant or withhold speech or religious liberty.
Ultimately, and in practice and in effect, HCR is a mandate on the citizens to behave in a particular manner because a bare majority of representatives say so.
On a different subject, what about those recalcitrants who refuse to buy insurance? Will they not be ‘uninsured’ and without access to health care except to the extent their own resources allow for it? Or, will they be penalized 2K and allowed access via Medicaid or Medicare? What if they don’t have the 2K?
On yet a third subject, what does the Plan give us if insurers’ expenses consistently and significantly exceed revenues and a sizable portion of the private sector goes belly up? Has anyone thought of that? Just asking, as they say.
Our economy, in the long run, will be unable to sustain this burden.
Yes, yes, fire and brimstone will come down from the skies, the rivers and seas will boil, forty years of darkness, earthquakes, volcanoes, the dead rising from the grave, human sacrifice, dogs and cats living together, mass hysteria. We heard you already.
McKinneyTexas: This is a train wreck. It is not some incremental experiment that can be tweaked and adjusted and shelved if it doesn’t pan out. It is virtually irreversible. Our economy, in the long run, will be unable to sustain this burden
Oddly enough, I agree that the current attempt at health care reform is a mess. It would fairly obviously have been better, simpler, and cheaper to extend Medicare over the whole population, instead of the current attempt to marginally improve US health care from its present rotten state with due regard for the profits of health insurance companies.
So, McKinney. If you agree the present far-too-right-wing far-too-careful-of-corporate-welfare reform is a train wreck, where do you stand on the simpler, cheaper, and more effective improvement of establishing an American NHS?
Jes, I would exchange dental floss for barbed wire and floss twice daily before going the NHS route, notwithstanding your unqualified admiration for it. With all due respect, our wait times are hugely better, the range of treatment modalities far exceeds yours, our outcomes across the board are better and, as a general matter, I am philosophically opposed to government ownership of any industry.
Granted, our system does not reach everyone. However, there are over 300 million of us and we are for more heterogeneous, culturally/ethnically/economically than any other country in the world. What works in countries of less than 100 million, often less than 50 million largely homogeneous people won’t work nearly so well here. Whatever inefficiencies exist on a smaller scale will significantly increase on our scale. Put differently, those who resent US chauvinism when the message is sent that Americans do things better should respect the fact that not every American is anxious to follow the lead of other countries.
We heard you already.
You heard, but you did not listen. Worse, you didn’t do the work and engage in the self-critical analysis to find out if you were wrong. Be as dismissive as you like, but don’t tell yourself that you’ve thought all of this through, look at both sides objectively and can substantiate why yours is the better way.
” If a private citizen used his/her own funds to buy the vote of a sitting senator, that would be a felony. If elected officials use taxpayer funds to bribe other elected officials, that’s just good clean fun.”
Congress is different, don’t you realize that? For instance, the ethical level that gets you impeached as a federal judge, qualifies you to chair the rules committee. Not just is irrelevant, mind you; It’s job related experience.
With all due respect, our wait times are hugely better, the range of treatment modalities far exceeds yours, our outcomes across the board are better
This is blatantly false in every respect. Our outcomes are worse across the board, and wait times are marginally different.
And regardless, the UK spends far less per capita on health care than the US! The problems associated with the NHS would improve if they spend as much per capita as we do.
Unless you have a cite? Link? Didn’t think so.
And McTex: Heterogenous? Really? What the heck does that have to do with anything.
On a different subject, what about those recalcitrants who refuse to buy insurance? Will they not be ‘uninsured’ and without access to health care except to the extent their own resources allow for it? Or, will they be penalized 2K and allowed access via Medicaid or Medicare? What if they don’t have the 2K?
If they don’t buy insurance, they pay a penalty. If they don’t have the amount to pay the penalty, they receive subsidies from the federal government to buy insurance instead.
instituting a systemic overhaul of this magnitude by people who, by and large, have never run a large company, have never successfully managed a health insurance company and who are essentially theorists ought to be, on its face, an obvious recipe for disaster
Jeebus man, you do realize that government provided insurance has been tried in a few places on the planet before, right? As in all other industrialized nations, and some non-industrialized nations.
Further, you do realize that, currently, through Medicare and Medicaid there is already a lot of government provided insurance in the States?
Even today, entitlement spending is predicted to swamp the budget in the mid term.
If we continue to outspend the rest of the world combined on defense, and we don’t slightly tweak the entitlement programs.
Social Security is fully solvent for the next 60 years. After which, there will be slight, gradual reductions in payouts. There are many ways to fix this.
Medicare is slightly more problematic, but nothing that returning to 1990s levels of taxation can’t fix.
On the contrary, I’ve spent a year and a half listening to Republicans explain why this bill will be an economic disaster with an open a mind as I can muster, and I haven’t found anything you guys have said to be convincing.
Even the cost estimates for this bill were 100% off – that is, the 10 year cost was $2 trillion and not $940 billion as the CBO says – that would amount to 1.3% of the $150 trillion GDP of the US over the next 10 years. 1.3%. How does a 1.3% shift in spending produce economic apocalypse? There is no credible way to make that argument.
As for the argument that the US is too “culturally/ethnically/economically heterogeneous” to make health care work, what on earth does culture or ethnicity have to do with health care? You’re treading awfully close to dog whistle territory there.
Missing word: “Even IF the cost estimates for this bill were 100% off”.
And on Ezra Klein:
If what he writes is wrong, then it’s wrong.
I don’t cite him as if to say that simply becuase he said it, case closed.
By all means, challenge his assertions with fact and evidence, and we can discuss the disagreement.
But really, to harp on the fact that Klein was cited is a huge misdirection away from rational discourse.
If a health care system’s goal is to improve the health of the population, it’s pretty well known that the USA is not at, or even near the top. Bottom-line statistics such as life-expectancy and infant mortality rates indicate this.
We do spend more — a lot more — than anybody else in the world, and we get more care for that. The trouble is, more care does not translate into better care. More than a few times more care means worse care. The Dartmouth Atlas of Health Care has taught us that, and much more besides. So, even if you have the money and the insurance, US healthcare is not clearly the best in the world. I do wish that meme would go away.
This is a train wreck.
Yes, it’s a freaking mess.
It’s also the best bill we’re going to be able to pass.
Personally, I think a single payer plan is inevitable. Not because of evil creeping socialism, but because it doesn’t seem like it’s particularly economic to sell health insurance for profit.
I’m not sure there’s enough money to be made at it without screwing people over in one way or another. There’s not enough money to be made at it without trying to find ways to exclude people who actually get sick, or who are likely to get sick, or whose illness is likely to be relatively expensive to treat.
And if you can’t make care available to the people who *actually get sick*, what’s the point?
There are too many chronically ill people in this country, and the expectation of what constitutes a “reasonable return on capital” is just too freaking high. You can’t get filthy stinking rich selling health insurance to people in this country without screwing a lot of them over.
That being so, it should just be taken out of the market, because the market will not get it done to anything approaching an acceptable level and quality of service.
But that’s not going to happen for at least another 20 or 25 years.
In the meantime, we’re either going to live with the legislative Frankenstein we’re looking at now, or we’re going to do nothing.
To all of you conservative commenters here who think extending Medicare to the uninsured is a good idea, I applaud you, but that’s not a realistic alternative to the bill on the table. It’s not a realistic alternative, because every Republican in Congress will hang themselves with McKinney’s barbed wire before they’ll vote for it.
The bill is a mess. That’s because the legislative process in this country is a mess.
In fact, it’s because the country itself is a mess. We can’t agree about a single damned thing. In the richest country in the world, we can’t even agree to make the simple, basic rudiments of a safe and decent life accessible to our own people.
So the bill on the table is our best available shot. Like it or not. This is kind of self-evidently true, because it’s the bill that was produced by the actual law-making process that we actually have.
It’s this or nothing. Kinda sucks, but we got nobody to blame but ourselves.
And no, “nothing” would not be better.
what russell said
And the ten year cost of $940 billion is easily saved by not electing a Republican who’ll invade and occupy Iran.
I agree with russell — single payer is inevitable. But that won’t happen until costs truly hit the brick wall they are headed for presently. The current bill makes feeble attempts to reign in costs, but it won’t be enough. Fee-for-service medicine is hard-wired to increase costs by increasing utilization. Until that stops, and until we stop paying for care that people may want (because somebody’s convinced them they need it, but doesn’t work), costs will continue to rise faster than inflation.
Further, you do realize that, currently, through Medicare and Medicaid there is already a lot of government provided insurance in the States?
Medicare and Medicaid combined cover about 100 million people. So, there is some institutional experience there.
a systemic overhaul of this magnitude by people who, by and large, have never run a large company, have never successfully managed a health insurance company and who are essentially theorists
A funny story: for odd reasons, I attended the National Funeral Directors Association banquet in Boston last fall. Every year, they elect a new President.
The new guy this year began his remarks by claiming he could probably do a better job of running the country than Obama. His credentials: he operates three funeral homes in Mansfield OH, and he’s a Big Man On Campus in the NFDA.
I have tremendous respect for anyone who can build a successful small business. But all I could think when this guy decided to crack wise was that he’d sh*t his pants if he woke up one day to find himself in Obama’s shoes.
Seriously, the guy went from solid citizen to loudmouth @sshole in one wisecrack. Stick to the funeral biz, dude.
It’s great to have a great idea, bootstrap a good business, make payroll, provide useful goods and services. Seriously great.
It’s not the same thing as public governance, and the sooner conservatives get that idea the hell out of their heads, the better off we will all be.
Brett,
No, I understand insurance: It’s a way of taking a 1% risk of a $10,000 expense, and turning it into a predictable $100 expense you can budget for each year. You want a large enough pool to even out the statistical variations from year to year, but it’s got NOTHING to do with roping in people who aren’t subject to the same risks.
What’s missing here is the issue of when you put people in the pool. If you put everyone in early, say when they turn eighteen, the lifetime risks are broadly similar. Individual risks diverge later on. So if you can establish that everyone goes into the pool at eighteen, stays in it, and pays an actuarially fair premium (measured over a lifetime, in present value terms), you have a sensible system.
Of course there are practical difficulties with that, but the critical thing to me is that health care insurance should be a lifetime contract. Otherwise it loses some of its insurance value. By requiring insurance companies, in the aggregate, to provide such contracts you accomplish a lot.
“So if you can establish that everyone goes into the pool at eighteen, stays in it, and pays an actuarially fair premium (measured over a lifetime, in present value terms), you have a sensible system.
Of course there are practical difficulties with that, but the critical thing to me is that health care insurance should be a lifetime contract.”
I agree, the closer insurance is to a life-long commitment on both sides, the more sense it makes. That’s one of the reasons it’s so important to break the link between employment and insurance which current tax law enforces.
” By requiring insurance companies, in the aggregate, to provide such contracts you accomplish a lot.”
This bears as much of a resemblance to a long lasting relationship with the same insurer, as a series of one night stands does to monogomy. You need to make it so that insurer really don’t suffer a loss from taking on somebody with a preexisting condition, or gain from getting rid of them.
A quick suggestion, which I candidly haven’t thought through yet: Require insurers, when somebody they cover gets a long lasting condition, to purchase an annuity to cover the difference between that person’s new risk, and the standard risk. Which annuity would follow them from one insurer to another. Then they’d have a motive to keep customers who got chronic conditions, and not regret getting in new customers who had them.
‘Tell you what, though, since you’re so married to this concept like a dog with a bone: Find your nearest residential neighborhood, choose to drive 60mph down the street, and then choose to blow through a couple stop signs. When you get pulled over, given a field sobriety test, and possibly cuffed, tell the arresting officer how important “choice” is to you. Let us all know what happens.’
I know you are into predictions, so why don’t I get back to you the first time I don’t get to choose how to handle my personal healthcare.
Is that your pissy way of admitting that belonging to a functioning society sometimes entails restrictions on your liberty and choices? If so, we can move forward from there.
But I can pre-empt you by telling you about a time when I didn’t get to choose how to handle my personal healthcare, at least not without exercising Hobson’s choice. It was just three days ago, regarding physical therapy for my hip and leg. Not that you care, because in this case, it was an insurance company limiting my choices, which means it wasn’t government, which means it was OK.
Yeah, you can tell us about that, and I can tell you about my insurance company paying out $80,000 in the last three months without a trace of complaint, treating my second cancer in the last six months.
Nobody has any problems when insurance companies (or banks, or car dealers, or grocery stores, or . . . ) do the things they’re actually in business to do, Brett. And my insurance company has, by and large, been very good for the 14 years I’ve been at my job, with rare exception. This case was an exception, and resulted in a limitation of my personal choice. Which was my point. As you know.
I agree, the closer insurance is to a life-long commitment on both sides, the more sense it makes.
But I don’t think you can do that without government involvement.
This bears as much of a resemblance to a long lasting relationship with the same insurer, as a series of one night stands does to monogomy. You need to make it so that insurer really don’t suffer a loss from taking on somebody with a preexisting condition, or gain from getting rid of them.
But you can’t necessarily maintain a relationship with one insurer. Companies go broke, or they don’t operate in some place you move to, or something else happens. The general idea is that as long as they are all under the same rules, then an individual company will sometimes gain, when a sick person switches away from them, and sometimes lose, when they have to cover someone with a problem.
In the aggregate it balances out (and I suppose reinsurance will be available to the companies). No doubt some insurers will play games around this, but the idea is basically sound. Of course, with single-payer this wouldn’t even be a problem, but…
There’s that chin again. Surely, you realize that the $80,000 figure you give is probably inflated, and the insurance company negotiated it down (because of that pool effect you dismiss so readily) and you are willing to claim that everything is no problemo.
Yeah, I’m aware of that, I get explanations of benefits, and read them. They negotiated it down to about $40,000, still no mean sum to hand out without complaint, and on top of the cost of treating my other cancer last year.
Wrongful recision is a terrible evil, but it’s also the exception.
They negotiated it down to about $40,000, still no mean sum to hand out without complaint,
If only they collected money from someplace on an ongoing basis to offset that sum.
A quick suggestion, which I candidly haven’t thought through yet: Require insurers, when somebody they cover gets a long lasting condition, to purchase an annuity to cover the difference between that person’s new risk, and the standard risk.
My quick suggestion, FWIW: get health insurance out of the private sector.
As long as it’s in the private sector, somebody has to make money on it, or it doesn’t happen.
As long as somebody has to make money on it, the emphasis is going to be on limiting exposure, rather than actually making health care available.
I recognize that your insurer came through for you. That’s great.
Everyone should have the same experience you did. They don’t.
On Ezra Klein:
The thing I find annoying about citations to him recently is that they are citations to him on budgetary issues, which is to say well outside his area of expertise and areas where frankly he seems obviously wrong on a fairly regular basis.
To cite him on the issue of CBO gaming feels like an appeal to authority that isn’t even within his area of authority.
And frankly I still haven’t seen a good legitimate reason why the tax is put 4 elections out. It is being described as a ‘concession’ to unions, but that only makes sense in a very surface way. Unions HATE it becuase they have great plans that are all going to get hitwith the tax. Unless their members (especially the ones that have retired or will retire in the next ten years) all suddenly die, that is stil going to be true four elections from now. So it isn’t much of a concession, unless the obvious plan of not really doing the politically painful thing *then* just like you don’t want to do it *now* is he real plan.
And frankly I still haven’t seen a good legitimate reason why the tax is put 4 elections out.
Your skepticism is not irrational, Sebastian, but I do think there is a plausible reason for the delay. The argument as I understand it is that current union contracts, with their Cdaillac plans, were negotiated on the assumption that the benefits were tax-free. The delay allows some time for existing contracts to expire or otherwise be renegotiated to reflect the new tax rules.
“The delay allows some time for existing contracts to expire or otherwise be renegotiated to reflect the new tax rules.”
Right, I’ve heard that explanation too, but it is kind of lame. The largest percentage of these people are already retired or near enough to retirement that renegotiation is impossible. And what are they going to do, be forced to abandon their really good health plans? That hardly seem plausible. The irritating thing is that we are going to be 8 years from now, and in exactly the same situation as we have had for 12 years of Medicare ‘cuts’, but there will be zero political accountability for it. (Which brings me to one of my recent pet peeves. Pretty much any time politicians put the day of reckoning off more than an election is a sign that they don’t intend to do it, and it should be treated a if they are.)
The motivation for it being 8 years out seems pretty straightforward. If your boss said you could have a paycut in 2 years or in 8 years which one would you pick?
As for Ezra’s expertise on CBO scoring, I thought he made good arguments, which is why I linked to them. It wasn’t an appeal to authority, it was an appeal to informed opinion backed by facts and analysis. You can disagree, but I haven’t seen a factual argument for your disagreement, just your opinion that these cuts will never actually be enacted. I see no reason for that to be the case – the exact same pressures that caused them to be included in the bill will still be present 8 years from now when they are due to come into effect. You have to explain why the Democrats were forced to include them today but would not face the same pressure in an attempt to repeal them 8 years from now.
For the Medicare doctor fix, the explanation is pretty simple: the cuts from the original formula are large enough that thousands of doctors would be likely to stop working for Medicare patients. No such threat exists for the excise tax – it is a high-end marginal tax and will not affect the basic provision of care, and since union members will have 8 years to prepare, they’re unlikely to be closely attached to pay deals with healthcare provisions exposed to a 40% tax by then. There won’t be any pressure by then, and it won’t be repealed.
And your not-very-hidden message is that the whole bill is a scam and that the people supporting it are intentionally lying about the cost. Talk about facts not in evidence.
I’m not sure where you mind-read the whole bill being a scam part, but you’re wrong.
The only reason the Medicare increase is so much NOW is because Congress has been putting it off for a decade. Kinda like how they are putting off the excise tax 8 years…
Also, I’d like to note “thousands of doctors would be likely to stop working for Medicare patients.” for those here who have claimed that no such threat exists. Would you like to argue with Jacob on that point, or is that only reserved for conservatives who make that point…?
“and since union members will have 8 years to prepare, they’re unlikely to be closely attached to pay deals with healthcare provisions exposed to a 40% tax by then.”
Huh? What about all the people who are retired now, or have a near term retirement? They are locked into their healthcare plan for the rest of their life already. That is why the unions have been complaining. Unless they die, they are going to hate that tax.
“You have to explain why the Democrats were forced to include them today but would not face the same pressure in an attempt to repeal them 8 years from now.”
Because promising that someone else in a future Congress will pay the political price is easy, but when it ACTUALLY comes time to pay the price it is hard.
Which *again* is exactly like the Medicare cut case.
So I still haven’t heard a good reason to wait four elections to implement this. If you want to give people a year or two to plan fine. 4 congressional elections and 2 presidential ones is a bit much. And when they don’t do it, you won’t even remember this conversation. Because it will have been eight years. Which is the plan…
I’m in mourning now: My current, very nice health insurance is now illegal, in a half dozen ways. Contrary to Obama’s lying promise that I could keep my current coverage… I have every reason to believe that what replaces it will be decidedly inferior.
That a lot of the bastards who voted for this are going to lose their seats will be minor consolation.
I have every reason to believe that what replaces it will be decidedly inferior.
I’m sorry: that must be deeply worrying for you, to be put into the position of the millions of people whose fate you have been so indifferent to during these discussions.
I advocate you move to another developed country with a better healthcare system. While I have to admit I don’t support your politics, I have no wish to see you die for them, and so while Afghanistan outside Kabul would fit your repeatedly-expressed desire to live in a country without government, I for one would welcome your moving to the UK so that you could pay taxes to and receive health care from an improved health insurance plan than your old one – even if you then voted for the BNP.
My current, very nice health insurance is now illegal, in a half dozen ways.
Can you detail those for us, or should we just take it as a matter of faith?
That a lot of the bastards who voted for this are going to lose their seats will be minor consolation.
I wouldn’t bank on it. The GOP is going to dial the crazy up to 11 and look even less appealing to the average-joe voter than they do now. And the tea party people are, on average, so goddamned stupid that by November they’ll be far too concerned with the new season of “The Bachelor” or some crap to even remember there was a March this year.
Our outcomes are worse across the board, and wait times are marginally different.
Really? We discussed this a couple of months ago and the stats clearly showed that cancer survival rates are far superior in the US. What studies can you cite to on other outcomes? I am not the proponent of HCR, you are. Where are your cites?
If they don’t buy insurance, they pay a penalty. If they don’t have the amount to pay the penalty, they receive subsidies from the federal government to buy insurance instead.
So, in other words, it’s a fake mandate for those who chose to spend their money on something other than insurance. Don’t pay, don’t buy, no problem, you’re still covered. No moral hazard here.
Eric, you are avoiding the big questions: under what clause of the US Constitution can the feds force an individual to buy a product, any product? It could be health insurance today, it could be a GM car tomorrow. Where’s your authority for this intrusion on personal choice?
More to the point, how do you square a government mandate with individual liberty? Answer: you can’t. Instead, progressives believe they know what is best for people and are perfectly willing to use the state’s police power to compel compliance with the progressive view of the world. This isn’t freedom, it’s statism. It may be relatively benign today, but then for those of us who thought today would never come, it is ominous. What can we look forward to in the future: mandatory daily calisthenics, regulated caloric intake, mandatory family planning? It’s all for our own good, after all. (I expect to get ridicule for the last statement, but am confident there will be no principled and coherent rebuttal to the charge of statism.)
Finally, congratulations on the Historic Win. The process sets a new high for democracy in action. Well done, Democrats. Now back to bashing conservative and Republican corruption.
Instead, progressives believe they know what is best for people and are perfectly willing to use the state’s police power to compel compliance with the progressive view of the world.
Conservatives are different, in that they believe they know what is best for people and a perfectly willing to use the state’s police power to compel compliance with the conservative view of the world. Or is that too much of a generalization?
C. S Lewis
So CharlesWT and McKinneyTexas are now on record as wanting to legalize all currently illegal drugs. Anyone else?
That is, to the extent CharlesWT has any actual thoughts or preferences of his own that cannot be expressed as a quote by somebody else.
Why do I give a crap what CS Lewis thought about anything, again?
Instead, progressives believe they know what is best for people and are perfectly willing to use the state’s police power to compel compliance with the progressive view of the world.
government is about telling people what to do. there is no such thing as a government which doesn’t tell people what to do. it’s the entire reason government exists.
now, if you don’t want a government, move to Somalia and spare us the moaning. please.
C.S.Lewis was also quite a religious fundamentalist (converted by Tolkien from atheism btw) which imo affected his writing negatively. Always willing to sacrifice (plot) logic to get his message through. Also a feared attacker of strawmen.
He could easily be categorized as a moral busybody himself (though not an omnipotent one).
The one thing to like about him is that he encouraged children to read and to use their own imagination, not to rely on pre-canned visions of others (he would have really hated the Disney-made Narnia films while possibly accepting the minimalist BBC version).
—
Btw, the English industrialists (their robber barons) were also quite some moral busybodies as far as other people were concerned iirc.
Really? We discussed this a couple of months ago and the stats clearly showed that cancer survival rates are far superior in the US. What studies can you cite to on other outcomes? I am not the proponent of HCR, you are. Where are your cites?
First of all, access to health care is kind of an important outcome. And in the US, 45 million don’t have any insurance at all, and tens of millions more have insurance that won’t cover certain severe illnesses.
Regardless, here is a study:
http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
Some other interesting facts, despite spending vastly more per capita than any other nation (which would seem to suggest that we SHOULD have better outcomes across the board):
The US ranked 33 in infant mortality in 2009. Not good.
The US ranked 24 out of 25 industrial nations on disability adjusted life expectancy
Other than South Africa, the US is the only industrial nation NOT to cover all of its citizens.
Also: the areas that the US tends to perform best in, comparatively, are areas of care to older Americans. Those would be the people covered by…Medicare!
(shiver)
“Can you detail those for us, or should we just take it as a matter of faith?”
High deductable policy.
Lifetime payout limit. (It’s in the millions, but it’s there.
FSA that isn’t limited to prescriptions.
Need I go on? That nobody would have to give up their current policy was a lie from the start.
That nobody would have to give up their current policy was a lie from the start.
Nobody? At all? Whose lie was that?
Factcheck on that, though a bit out of date.
Still no answer to the constitutional issue. Cleek et al are willing to acknowledge, indirectly, the statist mentality behind compelling citizens to buy a product.
Your “outcomes” article is non-responsive. What longitudinal studies are there that show better surgery results, better neonatal results, etc. in any comparably large population? None is the likely answer.
We can debate the infant mortality rates another time–your article does not control for cultural differences, lifestyle choices, etc. which are the principal driving factors on low infant mortality rates. Rather, your article is an agenda-driven, advocacy piece. Not a peer-reviewed comparison of like to like.
BTW, here is the definition of heterogeneous:
1.
different in kind; unlike; incongruous.
2.
composed of parts of different kinds; having widely dissimilar elements or constituents: The party was attended by a heterogeneous group of artists, politicians, and social climbers.
Even the Maine article notes, modestly, the issue of heterogeneity.
Here’s a shot at the constitutional issue.
Your “outcomes” article is non-responsive. What longitudinal studies are there that show better surgery results, better neonatal results, etc. in any comparably large population? None is the likely answer.
My study is much more responsive than yours. And the facts I cited, ditto.
Not a peer-reviewed comparison of like to like.
Where’s yours?
Still no answer to the constitutional issue.
That ship sailed centuries ago with the expansion of the commerce clause. See, also, HSH’s link.
Even the Maine article notes, modestly, the issue of heterogeneity
You defined heterogeneity, but the definition is not the problem. The problem is: how does that create health care problems that are unique to the US, such that insurance provided by the government will be uniquely difficult/impossible when the rest of the world manages just fine.
High deductable policy.
Lifetime payout limit. (It’s in the millions, but it’s there.
FSA that isn’t limited to prescriptions.
Need I go on?
Brett,
Help me out here. I know the current legislation does not allow for lifetime caps, but how would that proviso rescind your care? Wouldn’t it help, by removing the cap?
Ditto the other provisions.
Are you saying that insurance carriers can now drop people with policies that have lifetime caps? That wasn’t my understanding at all. Do you have any links discussing this requirement/allowance?
HSH,
This quote from your link actually made me laugh out loud:
“Rivkin and Casey argue that the mandate is not commercial in nature, because it’s triggered simply by “being an American.” This may be true, but it misses the point of the regulation: It requires Americans to engage in a commercial exchange. This is the definition of commerce.” (bold mine)
I am pretty sure someone will come up with better logic than this before it gets to SCOTUS.
This quote from your link actually made me laugh out loud:
Laughter is the best medicine.
Sullivan at The Daily Dish quoted Seth Masket from here with something I think is important:
Whether it is what you wanted or not, we now have federally mandated health insurance, forever. We now have a little more socialist country than we had before.
The question will be whether we fill up the jails with people who don’t want to buy it, or if we use that to justify single payer.
The question will be whether we fill up the jails with people who don’t want to buy it…
Thanks for returning the laughs, Marty.
I would not use ‘forever’ so casually, Marty. Many will work night and day to bring that to an end (preferably without leaving fingerprints).
how are the constitutional challenges to auto insurance and mortgage insurance going ?
“Some other interesting facts, despite spending vastly more per capita than any other nation…”
Exact same interesting fact, despite the federal government already spending more per capita than the UK on health care for every year in the past twenty, it still left all those people uninsured for two decades and those other facts that Eric quotes remain unchanged.
“The problem is: how does that create health care problems that are unique to the US, such that insurance provided by the government will be uniquely difficult/impossible when the rest of the world manages just fine.”
That is an interesting question in light of the fact that the US government already spent as much as those other governments. Why couldn’t it provide full coverage to the uninsured before?
Because there is something else going on, which this isn’t going to be fixing.
My take on this bill, is that to the extent the uninsured get covered, I’m thrilled. Which is moral victory, to be sure. To the extent that you think it helps when anything else, you’re deluding yourself. (Especially on budgetary ‘compromises’).
how are the constitutional challenges to auto insurance and mortgage insurance going?
Socialist!
Seriously, Americans can be so damned immature about political labels.
Anytime, HSH
“Socialist!
Seriously, Americans can be so damned immature about political labels.”
Seriously, Americans can be so naive about the consequences of their actions.
Phil: Why do I give a crap what CS Lewis thought about anything, again?
He had a great sense of humor and was an excellent tutor and lecturer – so my dad says, who was one of his students: he says CS Lewis had the teacherly knack of allowing his students to express their own ideas, uninterrupted except for clarifying questions – though he would then feel free to express his own.
Also, FWIW, while exceedingly conservative and therefore initially opposed to the NHS, he changed his mind – and said so – after his wife died of cancer, and he witnessed the care she received.
Marty: We now have a little more socialist country than we had before.
As I said to a friend of mine yesterday: conservatives are going to do more for the reputation of socialism by associating it with this bill than the Democrats ever have done for it.
This country is now a fraction more socialist, yes. For people who think that “socialism” and “capitalism” are not opposing forces bent on one another’s destruction – a life-or-death struggle between implacably hostile teams, one and only one of which you must identify with and support, but rather complements in the human endeavor to improve our collective lot, to be chosen between as the situation demands – this particular piece of rather mild socialism seems like a good idea, given the demonstrated inability of capitalism to provide a safety net for the unfortunate.
“given the demonstrated inability of capitalism to provide a safety net for the unfortunate”
This is not supportable but sounds great, you should send it to Obama, he could use it in a speech.
Perhaps you could spend a minute defining a safety net. I think a safety net exists, could be improved and could still be a safety net. This bill is not a safety net, nor does it cost what a safety net would cost.
“Brett,
Help me out here. I know the current legislation does not allow for lifetime caps, but how would that proviso rescind your care? Wouldn’t it help, by removing the cap?”
What I said is that my current policy has now been outlawed, not that every last feature of it was illegal, or that it was now illegal for me to get insurance. And it has. My employer will shortly be entering negociations with the insurer to come up with a new policy which complies with this law. It will, by law, have to be a rather different policy.
Seriously, Americans can be so naive about the consequences of their actions.
Yeah, we’re still suffering from socialist creations like the police force, firefighters, public schools, Social Security, Medicare, public highways, mass transit like buses and subways.
One wonders how we will survive some regulation of the private health insurance market.
This is not supportable but sounds great, you should send it to Obama, he could use it in a speech
Really? What safety nets did the private market create?
It will, by law, have to be a rather different policy.
Right, but the parts that have changed (no lifetime caps, high deduct) would make for a BETTER policy for you.
Fair enough, Jes, and if the late Mr. Lewis comes back to life and begins posting here, I’ll pay attention to him on that basis. In the meantime, if CharlesWT is going to post here, I’m more interested in what he thinks than in what he thinks CS Lewis thought.
There’s a Federal law requiring auto insurance and/or mortgage insurance?
I’d want to see a cite on that.
” Social Security, Medicare”
I like the way these get blithely get put in these lists. Do we just assume that these programs, that are now trying (by Democrats) to be sunsetted (SS) or delayed to 70 years old (both) because they are unsupportable from a budget standpoint are still considered successful?
The answer always comes back that they are popular (so would free popsicles) but they aren’t successful.
I like the way these get blithely get put in these lists.
I suggest you run on a blithe platform of repeal.
Do we just assume that these programs, that are now trying (by Democrats) to be sunsetted (SS) or delayed to 70 years old (both) because they are unsupportable from a budget standpoint are still considered successful?
Um, what? Unless we tinker a little bit, SS will begin to pay out less than the guaranteed benefits in about 60 years. With minor tinkering, SS is fully solvent for decades more.
The fact that a program needs tinkering is proof that…it isn’t successful? Jeez Marty, which government programs haven’t been tinkered with?
Medicare is less solvent, but that is because of the ridiculous health care costs/culture/delivery in this country. The answer, obviously, is not to cast old people out on to the private market which will refuse to cover them at anything other than enormous rates because…well, because they are old and tend to get sick and need expensive treatments.
Again, it needs to be adjusted. Part of that process began with the passage of HCR. More to come, but a great socialist program nonetheless.
And yes, I don’t see you clamoring for the dissolution of fire departments, police forces, highways, subways, buses, trains, public schools, etc.
The answer always comes back that they are popular (so would free popsicles) but they aren’t successful.
Successful? Medicare has been a huge success – saving hundreds of millions of seniors from earlier death than need be, and the indignity of lacking health care when in need most.
Social Security has provided an invaluable safety net to seniors, with hundreds of millions similarly spared.
Enormously successful.
You only have to have auto insurance if you drive a car on a public road and mortgage insurance only if you have a mortgage. You’re not required to have either one just by virtue of being an alive citizen.
“Successful? Medicare has been a huge success – saving hundreds of millions of seniors from earlier death than need be, and the indignity of lacking health care when in need most.
Social Security has provided an invaluable safety net to seniors, with hundreds of millions similarly spared.
Enormously successful.”
Has, has, has, success is a sustainable program that people can count on. I would be surprised if you believe that either are something you can count on when you reach 65.
Millions of seniors have benefited, but they may very well have been better off, with a more sustainable program. We certainly wouldn’t know because discussing any alternative is political suicide, those popsicles again.
“given the demonstrated inability of capitalism to provide a safety net for the unfortunate”
This is not supportable but sounds great, you should send it to Obama, he could use it in a speech.
Seriously Marty, take an hour or so and review the economic history of the US from the time it became and independent nation with a market economy, up through the regulatory and entitlement regimes instituted in the early 20th C and in the New Deal.
Boom, bust, bubble, panic. Lather, rinse, and repeat.
The capitalist motto is “root hog or die”. There is no capitalist safety net.
Has, has, has, success is a sustainable program that people can count on. I would be surprised if you believe that either are something you can count on when you reach 65.
I’m fully confident. These programs have already been tweaked more than once in the past. And will be changed again to make them run better.
The framework has been an enormous success and yielding the desired results. They have not, yet, in their many decades of existence gone bust. They will be changed and continue to be successful.
Millions of seniors have benefited, but they may very well have been better off, with a more sustainable program. We certainly wouldn’t know because discussing any alternative is political suicide, those popsicles again.
Wow. OK. So, in the hypothetical, there are possibly better programs. That’s an actual argument that these programs aren’t successful? They could have been better?
Anyway, as mentioned: these programs have already been changed. And will be changed again to make them run better.
Problem with “alternatives” is that proposals from the right come from people that opposed them on inception, and have tried numerous times to gut them since. So people tend not to trust the trojan horse gifts offered by such benefactors.
Millions of seniors have benefited, but they may very well have been better off, with a more sustainable program.
You mean like one with no FICA income cap? Sounds great! Let’s do it!
We now have a little more socialist country than we had before.
And for the record, what we have today is one sector of the economy that is somewhat more regulated than it was yesterday.
Not the same thing as a “more socialist country”.
There’s a Federal law requiring auto insurance and/or mortgage insurance?
Federal vs State isn’t the interesting bit. what’s interesting is that by law (in all the states i’ve ever lived in), i have to have insurance in order to drive a car.
i want to buy one product, but by law i have to buy an additional product.
nobody thinks that’s worth pretending to be an outraged constitutional scholar over? halp halp, my freedom is being trampled by your collectivist statism!
Ponzi schemes are much less likely to go bust when you can use coercion to keep bringing in new “investors.”
1. Anyone who uses the term “Ponzi scheme” when discussing Social Security can be safely ignored as a person whose opinion is, for all practical purposes, valueless. A Ponzi scheme is a very specific thing that has no features in common with SS. You want to debate it on the merits, great. You want to throw around chaff, not great.
2. Said coercion consists entirely of “being born here” and “collecting a paycheck.”
Ponzi schemes are much less likely to go bust when you can use coercion to keep bringing in new “investors.”
Right. But we were talking about SS and Medicare, not Ponzi schemes.
Please, try to stay on topic.
Phil, you asked for CharlesWT’s very own special thoughts, now he’s given them to you.
…though I think I liked him better when quoting C.S.Lewis. At least C.S. Lewis was too smart to think the welfare state was a Ponzi scheme.
“i want to buy one product, but by law i have to buy an additional product.”
I always wonder why people don’t have to buy insurance to buy a gun. Seems to resemble the car insurance guidelines of requiring liability insurance (which is all many states require)thus protecting others from your negligence.
Much easier to justify than buying health insurance and could price many potential gun buyers out of the market.
A few questions for the constitutional objectionists:
Does the Constitution permit the Federal government to impose a tax, rather than a mandate, on individuals?
Does the Constitution permit the Federal government to impose a tax on individual incomes, said tax to be a dedicated funding stream for, say, health care for the uninsured?
Does the Constitution permit the Federal government to grant exemption from that tax under certain conditions, e.g. proof of private insurance coverage?
–TP
I always wonder why people don’t have to buy insurance to buy a gun.
NRA.
Hoist on my own petard. š
I do find it amusing that the most horrible thing conservatives can find to compare SS to is a) something that happens exclusively in private investment and b) would happen about a thousand times more frequently without an SEC and the regulations they hate so much.
Nah Phil, corporations are best at regulating themselves. Doncha know.
Government is best at regulating itself, right? š
Government is best at regulating itself, right?
If we lived under an absolutely sovereign king, or a military dictatorship, or any of a number of other unaccountable authoritarian regimes, I’d say you have a point.
Given the actual government we have, I would trust government to regulate itself approximately 1,000 times more than I would trust corporations to do so.
The issue is that the actions and decisions of both government and corporations are taken by *people*. And people are responsive to the levers of transparency and accountability.
Our system of government has those levers baked in. Folks in government try, continually, to avoid them, but they are there.
Corporations, not so. They require them to be imposed from outside.
“And people are responsive to the levers of transparency and accountability.
Our system of government has those levers baked in. Folks in government try, continually, to avoid them, but they are there.”
Do they really? Not everywhere. When was the last time you heard a prosecutor getting fired (or even in trouble) for abusing prosecutorial discretion? How often do police officers get away with beating their girlfriends/wives without serious repercussions until they kill them? People who don’t read Balko probably think that SWAT team raids rarely end up killing the wrong people. How many hundreds of innocents have been put in prison over the past decades by the fraudulent autopsies of Hayne in Mississippi? If life and death issues like that slide for decades, why do you believe that less important things are even better managed and attended to? We actually are quite bad at watching the watchers.
We actually are quite bad at watching the watchers.
So who would be better at it?
–TP
We actually are quite bad at watching the watchers.
Everything you’ve said here is so.
And corporations would put freaking arsenic in your tap water if they could make money on it and get away with it. They’ve probably already done it, or worse.
Our lever in both cases is the law. The law is an instrument of government.
Not private industry. Government.
Look, I’ve talked about this before, so pardon me if I repeat myself. But I’ve met my House rep a number of times, had conversations with him on a variety of topics. His wife used to run a small business around the corner from me. His step-daughter is a good friend of a friend of mine’s daughter.
I know the names of the folks in his local office, and have had extended conversations with several of them.
When I call, they pick up the phone. When I write, they write back.
He’s a local guy. As he ought to be. And if I don’t like what he does, I can and will exert myself to replace him with someone else.
Ditto my state rep and to a lesser degree my state senator.
I know most of the selectmen in my town personally. If I have an issue with something in town, I can get on the horn and talk to them, or stop by their house, or meet them for coffee and talk it over.
No sh*t.
There is noone at a comparable level in any corporation of a size similar to my town, state, or country that I have any similar access to. Noone.
You are preaching to the choir when you talk to me about prosecutorial misconduct, crazy badass cops, or the militarization of the police force. I think all of that sucks.
But I would, hands down, trust any level of government in this country to police itself one thousand times more than I would trust any corporation of comparable size.
Hands down.
Yeah, cops have guns. And corporations have money, and they’ll kill you with that just as quick if it’s in their interest to do so.
Never mind money, corporations have their own guns. Nowadays it’s “corporate security”, but before it was made illegal they had their own private armies, mostly to kill or generally beat the crap out of labor organizers.
Corporations exist to amass wealth, and to protect the owners of that wealth from any adverse consequences of how that wealth was amassed, beyond the possible loss of the capital they have invested.
Their reason for existence is to limit the risk and responsibility of the people who own them.
They have, richly, earned the right to be kept on the tightest leash we can devise for them.
I will trust any level of government in the United States to police itself one thousand times more than any corporation of similar size. Hands down.
What size city do you live in that you can know most of the selectmen in your town personally?
What percentage of people in the US live in towns small enough for that to be true?
Corporations have never killed as many people as governments.
I guess my point is that I bristle at the seemingly unfounded idea that corporations need watchdogs and governments don’t. Or that corporations are resistant to consumer pressure, but governments listen.
Institutions tend not to listen. That is part of why they are institutions. That is true of governments and corporations, both. Institutions try to stack the game so that they don’t have to listen. That is true of corporations and governments, both.
I’d be more inclined to agree with you if governments had more transparency and accountability. For example, what happens when Congress decides to ignore its pact to cut Medicare costs for ten consecutive years? So far as I can tell, nothing. What happens when Congress passes negative sum laws like corn subsidies that cost the society as a whole, but unnecessarily benefit large scale farmers who don’t need it? So far as I can tell, nothing. What happens when a government shoots non-drug dealers each month in SWAT team raids for a decade or more? So far as I can tell, nothing…
What size city do you live in that you can know most of the selectmen in your town personally?
20,000 people.
What percentage of people in the US live in towns small enough for that to be true?
I have no idea. Probably a lot, but certainly not everyone.
The number of people corresponding to House Reps, however, is pretty consistent across the country. Folks could get to know their Rep if they wanted to. They just have to get off their behind.
See if you can get a VP at Bank of America, or even their personal assistant, on the horn. Give it a try and tell me how you make out.
Corporations have never killed as many people as governments.
You got me there. There are corporations who gave it a good run for the money, though. East India Company, all of the corporations that ran the plantation culture in the Western Hemisphere for a couple of centuries. They made a pretty freaking good dent.
Another good reason to keep corporations on a tight leash and out of the private army business.
I guess my point is that I bristle at the seemingly unfounded idea that corporations need watchdogs and governments don’t. Or that corporations are resistant to consumer pressure, but governments listen.
If I was saying either of those things, you would have a point.
What I’m saying is that the instruments by which government is made accountable are, in this country, an inherent function of government.
The instruments by which corporations are made accountable are not an inherent function of the corporation.
So, given the governments and the corporations that we actually live with here in the US, I would trust the government to police itself several orders of magnitude sooner than I would any given corporation.
I appreciate the examples you give of government malfeasance.
What happens when Congress doesn’t keep its promises, or passes stupid corn subsidies? We get to vote them out of office if we choose.
What happens when SWAT teams shoot the wrong people? If we can get our heads out of our @sses and quit freaking out about personal drug use, we can tell our towns and cities that we don’t want a freaking SWAT team running roughshod over the population.
Want my list of what corporations do and nothing happens? Trust me when I say you don’t have the time.
What’s our recourse when corporations do stuff that kills, maims, poisons, or financially ruins people? We don’t buy their soap and hope they see sense?
No. Our recourse is the law. Government.
That, or freaking pitchforks. Let’s stick with government.
There are corporations who gave it a good run for the money, though. East India Company, all of the corporations that ran the plantation culture in the Western Hemisphere for a couple of centuries. They made a pretty freaking good dent.
And as an aside, it’s not like the above doesn’t still go on. It just doesn’t go on in our backyard.
Go to any poor country with any kind of significant mineral or other natural resource, you’ll find that plantation culture and/or banana republic governance is still alive and well.
The heritage of this country is that the people are sovereign and self-governing. As a result, the levers by which government is held to account are inherent functions of the government itself. They are baked in.
If we don’t exercise our responsibility, it’s our own damned fault.
“What happens when SWAT teams shoot the wrong people? If we can get our heads out of our @sses and quit freaking out about personal drug use, we can tell our towns and cities that we don’t want a freaking SWAT team running roughshod over the population.”
So you’re saying we can’t do anything, right? Because they do kill the wrong people, all the time, and we don’t do anything to change it.
So you’re saying we can’t do anything, right?
No, Sebastian, what I am saying is precisely *not* that we can’t do anything.
To repeat, what I am saying is that I have greater confidence in the ability of the actual governments we have in this country to police themselves than I have in corporations to police themselves.
“We don’t do anything” is not, remotely, the same as “we can’t do anything”.
“We don’t do anything” is not, remotely, the same as “governments are not accountable”.
We, as a nation and a people, are apparently not particularly troubled by the fact that SWAT teams kill innocent people, because we could stop it in fairly short order if we were so inclined.
We don’t have a king, or a dictator, or a freaking Politburo. The military and police forces of the nation are under civilian control. Nobody is holding a gun to our head telling us that we must have SWAT teams, or that SWAT teams must operate under rules of engagement that permit them to kill innocent people without consequences.
We just don’t appear to give a flying you know what, which is a problem of an altogether different kind.
Could part of it be that politicians and police chiefs give press conferences, while people shot by SWAT teams must have had it coming? Or that the politicians can express regret, but assure you that it was all done under the rules of engagement?
It doesn’t take money to shape the discourse, power works fine too…
Oh, but I think that might be trumped by when you wanted to buy no products but are forced to buy one anyway. You can buy a car with no insurance, but you need it to drive. But one day soon you’re going to need health insurance if you breathe.
I think the fundamental error you are committing, cleek, is that your assessment of what bits are interesting isn’t agreed to by everyone.
http://www.cjr.org/the_audit/reuters_is_excellent_in_diggin.php
Could part of it be that politicians and police chiefs give press conferences, while people shot by SWAT teams must have had it coming? Or that the politicians can express regret, but assure you that it was all done under the rules of engagement?
It sure could be. And if you want to make it explicitly political, we can also drag in a half-century or more of coded “law and order” politics, and the racial issues underlying a lot of it, and perverse prosecutorial incentives, and hostility to “community organizers” who do attempt to respond to these issues and get kicked in the teeth for it, and a Supreme Court that’s often actively hostile to the rights of prisoners and criminal suspects.
Then ask yourself where conservativism has stood in response to all of those issues. (And centrists, for that matter. I certainly am not going to let Bill Clinton off the hook for any of it.)
Which is to say, if there’s any recent president most responsible for the militarization of the police and the attendant rise in these kinds of incidents, it’s Clinton. DHS funding for stupid toys for local cops was just Bush’s icing on Clinton’s cake.
Slarti: But one day soon you’re going to need health insurance if you breathe.
You say that almost as if you think that’s a bad thing.
Of course, it’s you, so who knows what you meant by it?
You can buy a car with no insurance, but you need it to drive.
which is a swell situation for the dozens and dozens of car collectors in the US. most people are not car collectors; most people buy a car because they intend to drive it.
It sure could be. And if you want to make it explicitly political, we can also drag in a half-century or more of coded “law and order” politics, and the racial issues underlying a lot of it, and perverse prosecutorial incentives, and hostility to “community organizers” who do attempt to respond to these issues and get kicked in the teeth for it, and a Supreme Court that’s often actively hostile to the rights of prisoners and criminal suspects.
Bingo.
SWAT teams and heavy police armament and tolerance for brutality got a real jolt during the civil rights era.
Nixon’s “law and order” was followed by “Willie Horton”/soft on crime demagoguery throughout the 80s and 90s, to “liberals worry about the rights of murderers/rapists” and the “card carrying member of the ACLU” – which was used as an insult – to the present day, “liberals worry about the rights of terrorists.”
That is at best a selective misremembering. Crime was important in 80s elections, because crime had skyrocketed under the 60-70s punishment philosophy where ‘rehabilitation’ and ‘understanding’ had swung too far.
It isn’t all racial subtext, there is quite a bit of actual text there–and the text was a largely correct critique. (Which reminds me of one of my least favorite things about post-modern analysis: fine analyze the subtext, but don’t forget the very important stuff that is right there on the surface.)
And being accused of being soft on murderers means that the only rational response for liberals is to authorize SWAT team raids on pot users? I’m not convinced.
How many police chiefs, sheriffs, municipal safety directors and district attorneys do you suppose could be safely categorizes as “liberals,” Sebastian? Ballpark a percentage for me, if you would.
What do you think would happen to a DA or sheriff who ran on a platform of maybe going a little lighter and less heavy-weapons on the drug raids? Especially in cities with the biggest drug “problems?”
It isn’t all racial subtext, there is quite a bit of actual text there
Good thing nobody but you said “racial subtext,” then. What I said was “racial issues.” Get one (1) reading comprehension, please.
–and the text was a largely correct critique.
What, exactly, does this mean?
And being accused of being soft on murderers means that the only rational response for liberals is to authorize SWAT team raids on pot users? I’m not convinced.
I may as well respond, “So because penal philosophies in the 60s and 70s may have become too lenient, the only rational response was for the Philadelphia police to drop a blockbuster bomb on a MOVE house?” But where does that get us, exactly?
Sebastian: crime had skyrocketed under the 60-70s punishment philosophy where ‘rehabilitation’ and ‘understanding’ had swung too far.
Crime skyrocketed under Reagan because it always does in a country with low social mobility and chasms of difference between rich and poor.
Understanding why people commit crimes and rehabilitating people who have been convicted of a crime is one of the proven-successful ways of lowering the recividism rate – but conservatives love high crime rates and hate investing that kind of money in poor people, so for them, attacking success is a win-win.
And being accused of being soft on murderers means that the only rational response for liberals is to authorize SWAT team raids on pot users? I’m not convinced.
Politically speaking, the rational response is to insulate oneself from the charges. Which means not leaving yourself vulnerable to the smear. Which means adopting rightwing policies on such matters.
The Willie Horton ad was effective. Nixon’s demagoguing on law and order was effective.
They turned “ACLU” into a slur. And now, you see it again with the demonizing of those that “care more about the rights of terrorists than the victims.”
This is nothing new.
Ideally, liberals would tell the GOP to stuff it and stand on principle. In the real world, politicians make rational decisions based on self-preservation – aka re-election.
“Crime skyrocketed under Reagan because it always does in a country with low social mobility and chasms of difference between rich and poor.”
I know you live in another country, but it might help to actually look at the history rather than spout off things just because they fit your preconceptions. In actual fact crime was very much down under Reagan. (Whether or not that had much to do with the presidency itself, is a different question.)
“Politically speaking, the rational response is to insulate oneself from the charges. Which means not leaving yourself vulnerable to the smear. Which means adopting rightwing policies on such matters.”
Which has what to do with SWAT times and non violent crimes?
“Ideally, liberals would tell the GOP to stuff it and stand on principle. In the real world, politicians make rational decisions based on self-preservation – aka re-election.”
Actually the problem is more complicated on crime. Ideally politicians would respond to facts, and the fact is that 60s and 70s crime policies failed miserably. The problem is that liberals linked good due process rights to bad punishment theories (premature paroling of violent criminals). Bad in the other direction, Republicans linked bad process rights to better punishment theories. Neither (as parties) seemed to be able to realize that process rights (figuring out if you were actually guilty) and punishment theories (figuring out what to do with you when we determined you were guilty) were pretty much different things that didn’t require a wholesale answer to both.
“Ideally, liberals would tell the GOP to stuff it and stand on principle. In the real world, politicians make rational decisions based on self-preservation – aka re-election. ”
I know I quoted it once, but I want to take a different direction as well. If you are aware of this, are you dismissive of the idea that pushing the excise tax past the next four elections is very likely to signal an intention not to do it at all?
Which has what to do with SWAT times and non violent crimes?
Any action that could be labeled “soft on crime” is to be avoided. Restricting the use of SWAT teams could be that.
Add into the fact that there is now a burgeoning prison-industrial complex that promises big campaign contributions to pols that adopt “tough on crime” measures.
You know how hard it has been to get even a partial repeal of the Rockefeller Drug Laws in NY? A very blue state?
If you are aware of this, are you dismissive of the idea that pushing the excise tax past the next four elections is very likely to signal an intention not to do it at all?
I think it depends on how hot an issue it is then.
I know you live in another country, but it might help to actually look at the history rather than spout off things just because they fit your preconceptions. In actual fact crime was very much down under Reagan.
Actually, the overall crime rate peaked in 1980, fell somewhat for the next three years, then began a steady rise until it peaked again in 1991, after which it fell again. Cite available on pp. 36-37 of this PDF: http://www.jrsa.org/programs/Historical.pdf .
Falling from a peak of 5,950 crimes per 100,000 population to just over 5,000 over a period of two years, then beginning a steady rise over the next eight, hardly counts as being “very much down under Reagan,” so spare us the lecture, Professor.
(BTW, if you dig deeper into the PDF, the murder rate decreases/increases mirror the overall crime rate, while drug arrests declined under Carter, than began rising steadily in 1981 until hitting a massive peak in 1989, declining again, then hitting even bigger peaks in 1995 and 1997. All of which pretty much reinforces exactly what I said.)
Oh, Phil is talking to me again. Joy. We know how bad you are with facts and statistics, trolling, and general misrepresentation of arguments while being incredibly rude in the process .
The graph you link absolutely shows an enormous decline in murder rate right at 1980. (Which I would argue has very little to do with Reagan per se but whatever). Jes claimed “Crime skyrocketed under Reagan because it always does in a country with low social mobility and chasms of difference between rich and poor.” which, if you ever were capable of disagreeing with people on your side, you would recognize as a false statement. But you can’t, and don’t, so of course you didn’t.
Does your graph support “crime skyrocketed under Reagan” Hmmm, no.
Since you were the one who requested that we not address each other, does this mean I should resume pointing out each time you are trolling, twisting people’s words or otherwise attempting to destroy the debate?
Phil, you wrote
“Good thing nobody but you said “racial subtext,” then. What I said was “racial issues.” Get one (1) reading comprehension, please.”
You earlier said:
“And if you want to make it explicitly political, we can also drag in a half-century or more of coded “law and order” politics, and the racial issues underlying a lot of it…”
Do you know what subtext is?
Holy crap, Sebastian. Here was your claim, in its entirety:
In actual fact crime was very much down under Reagan.
Fact: The overall crime rate, per my cite, rose for 5 of Reagan’s 8 years in office, from 1983 to 1988.
You want to restrict your claim to the murder rate, say so, but don’t make one claim, then argue another. The murder rate is not the crime rate. Meanhile, I’ll take that apology in the form of cash or you fucking yourself.
Do you know what subtext is?
Yes, I do. Do you know that “underlying” is a synonym for “forming the basis of,” which is a different concept from “subtext?” Don’t answer, because if the answer is anything but “No” then you are clearly lying.
We know how bad you are . . .
Speak for yourself, and the frog in your pocket, kid.
if you ever were capable of disagreeing with people on your side
Yeah, because I’ve never disagreed with Jesurgislac about anything. God, you’re dumb.
Jes claimed “Crime skyrocketed under Reagan because it always does in a country with low social mobility and chasms of difference between rich and poor.” which, if you ever were capable of disagreeing with people on your side, you would recognize as a false statement. But you can’t, and don’t, so of course you didn’t.
Huh? He was refuting your claim that crime was “very much down under Reagan”, and said nothing in support of the claim of skyrocketing crime.
“Yes, I do. Do you know that “underlying” is a synonym for “forming the basis of,” which is a different concept from “subtext?” Don’t answer, because if the answer is anything but “No” then you are clearly lying.”
No you apparently don’t know what subtext is vs. text. Claiming that coded racial issues are the underlying purpose behind law and order politics is a claim that the racial subtext is at least as (or in the case of your claim more) important than the law and order surface text.
That is how post modern subtext arguments work. Which is precisely why I said “(Which reminds me of one of my least favorite things about post-modern analysis: fine analyze the subtext, but don’t forget the very important stuff that is right there on the surface.)”
And by the way, you are completely aware of our policy against using certain specific words like F!@#$. Do it again and you get banned.
Of course that is exactly what I was talking about–you know the rules here, and you don’t care. You’re all about fireboming the conversation all the time. You’ve even admitted that in the past.
To demonstrate that I know what I’m talking about, and to ensure that Sebastian cannot simply assert victory and pat himself on the back, here is the graph I linked to. I drew in lines showing the date at which the crime rate reach its minimum under Reagan (a little after 1983) and the lowest crime rate achieved (just over 5,000 crimes/100,000 pop.) Click the image for a full-sized version.
If, on that basis, anyone who is not named Sebastian thinks that a decline, over a three-year period, from 5,950 to 5,000 crimes per 100,000 population, followed by a steady five-year rise, is the same thing as being “very much down,” I’ll concede the argument. Anyone?
You’re all about fireboming the conversation all the time. You’ve even admitted that in the past.
Cite and support, or retract and apologize. Now.
And, by the by, if you don’t want to get the f-bomb dropped on you, don’t accuse me of being “bad . . with facts and statistics, trolling, and general misrepresentation of arguments” while I’m staring at a graph that proves you wrong about a particular factual point. And don’t you dare then threaten to ban me after doing so.
Not a threat, straight out enforcement of the clearly defined rules. Which by rights I should have banned you for now, but I did incite you. As for the rest, it is straight up your history at this site. You’ve been close to being banned (by hilzoy when she was here) for years.
Shall I take it that you’ve abandoned your subtext vitriol without comment? Is that yet another example of your baseless firebombing of conversations?
Sebastian: but it might help to actually look at the history rather than spout off things just because they fit your preconceptions
I see Phil already helpfully cited the stats that refute this slur.
It’s my fault, I admit it: I have a nasty liberal smart-assed habit of changing my views to fit the facts available, unlike the pure conservative who sticks to their views and thinks the facts just ought to match up…
Shall I take it that you’ve abandoned your subtext vitriol without comment?
No, you can take it that I’ve established you as sufficiently incorrect enough on the “crime was very much down” point that embarrassing you any further would be counterproductive at this point. But if you’d like to say anything else incorrect we can proceed forward from there.
As for the rest, it is straight up your history at this site.
I asked you for cites and support, or an apology and retraction, and your next post will consist of one of those two things or I will be taking it up with the kitty. And to the extent to which the kitty includes you, you will be politely recusing yourself from any ensuing discussion due to bias.
I will not be insulted and subsequently threatened with banning, accompanied by insinuation that a former highly respected poster wanted to ban me, by someone who has posting and moderating privileges. Even less so by one who found himself on the wrong side of a factual point.
You’ve been close to being banned (by hilzoy when she was here) for years.
As hilzoy is not here to confirm or deny this little tidbit, I’ll take it as you attempting to further smear me. Hilzoy is an adult woman and, if she wishes to, may return here and speak on this topic for herself. So you can apologize for this as well.
And if there’s a sufficient number of other regulars here who will attest that my “straight up history here” consists of “fireboming the conversation all the time,” and that I’ve “even admitted that in the past,” then, fine, you can shut the door on me. But if that’s the case, those cites should be easy enough for you to come by. So let’s see them, or make with the apology.
“I asked you for cites and support, or an apology and retraction, and your next post will consist of one of those two things or I will be taking it up with the kitty. ”
You’ve had a lot of nasty comments. I’m sorting through them now. Thanks for your well known patience. š
Btw, what will you agree to do when I find them?
which is a swell situation for the dozens and dozens of car collectors in the US. most people are not car collectors; most people buy a car because they intend to drive it.
There are probably also at least a couple dozen people in the US who donĀ“t own a car at all.
More to the point, thereĀ“s a small difference between the government requiring you to buy a product if you wish to use the roads that the government builds and maintains, and the government requiring you to buy a product just for existing.
…and the government requiring you to buy a product just for existing.
Just existing pretty much guarantees that you’ll use health care at some point.
Sure, but I donĀ“t see how that makes the analogy of compelled auto insurance and compelled health insurance apt.
The difference, I think, is that you are not required to buy health insurance at all – and you don’t suffer any criminal penalty for failure to do so.
You are assessed a tax that you can be exempt from if you buy insurance.
Which is, ultimately, how it passes constitutional muster.
Ahh, I see you have abandoned the subtext thing. Funny one who demands apologies on a very regular basis can go for rude demands at “Get one (1) reading comprehension, please”.
Oh and I have to have wronged you, to apologize. So I won’t be.
Compelled auto insurance applies to people who drive, and it does because a lot of people who drive wouldn’t get it otherwise, particularly those who lack assets to be taken in law suits. This would leave those with insurance, who need to protect their assets, at risk of uncompensated damages, requiring them to either accept that risk or pay more to insure against it – the risk of loss beyond their own liability. It’s no skin off the insurers’ backs in the case of auto insurance, but it’s bad for the insureds.
Without compelled health insurance, considering the prohibitions against rescission and denial of coverage for pre-existing conditions, the healthy would tend to forego coverage, leaving a sicker pool of insureds and driving up costs on a per-insured basis. This, of course, would mean higher premiums, which is bad for the insureds.
Now, it’s not exactly the same, since auto insurers wouldn’t go out of business without a mandate. But driving is what makes auto insurance mandatory, since you might cause an accident. Not everyone drives.
Being alive is what makes health insurance mandatory, since you might need health care by the mere fact of being alive, regardless of what you do – drive, don’t drive, own a home, don’t own a home, etc. Since everyone mandated to get health insurance is alive, the mandates are proportional and reasonably analogous, IMO.
I guess it would have been faster to simply write “If you drive, you need auto insurance, because you might cause an accident. If you are alive, you need health insurance, because might (really, ‘will’) need health care.”
So be it, Sebastian. To the kitty I go.
In the interests of transparency, and because I value the input of the community here, this was just sent to the kitty:
Anyone who has read this thread — http://obsidianwings.blogs.com/obsidian_wings/2010/03/the-best-health-care-system-in-the-world.html — today has seen said interaction, so here are my complaints, which I’d like addressed:
1. While my posts addressing Sebastian, beginning here, were in many cases sarcastic, I don’t believe they were particularly out of bounds nor rude. No more so than what occurs in dozens of posts each day at ObWi. And the one I’ve linked to here contained sufficient informational content that Eric certainly agreed with it.
2. Only when I bothered to fact-check Sebastian, here, did he respond by calling me “bad . . . with facts and statistics, trolling, and general misrepresentation of arguments while being incredibly rude in the process.” Please note, the rudest thing in the post to which he is responding was “Spare us the lecture, Professor.”
3. Also please note that he was wrong on the factual point in question, to which he reacted by attempting to change the topic from “crime rate” to “murder rate.” He then closes out by accusing me of “trolling, twisting people’s words or otherwise attempting to destroy the debate?”
4. Having thus insulted and provoked me, apparently because I fact-checked him and sarcastically called him “Professor,” I respond with a post including a profanity.
5. Sebastian then threatens to ban me, and claims that I am “all about fireboming the conversation all the time.”
6. When I ask him to support that statement, or retract it an apologize, he not only repeats the threat to ban, but drags hilzoy’s name into it. This I find particularly insulting as: a) hilzoy is no longer a poster at ObWi, b) her name and her opinion carry a great deal of weight, and c) Sebastian making this claim can therefore serve no purpose other than to give his ban threat undue authority and to embarrass me.
So, to summarize:
— After several posts in the thread by me which go unremarked upon, I fact check a claim of Sebastian’s.
— He turns out to have been incorrect in his claim.
— He reacts by insulting me and characterizing my entire contribution to ObWi as “firebombing.”
— When I get pissed about that, he threatens to ban me, and invokes the mantle of hilzoy in doing so.
— When I demand support for his claims about me, or retraction and apology, he says he “hasn’t wronged me,” then once again tries to move the goalposts from “trolling, twisting people’s words or otherwise attempting to destroy the debate” to “nasty comments.”
Do I have a temper? Yes. Can I be sarcastic? Yes. Should I have used profanity? No. Is Sebastian’s behavior here appropriate for a front-pager? Absolutely not. Does he owe me an apology? I certainly think so.
Well I’m going through your approximately 4000 comments on this site, Phil (Do you know they go back to 2004? I certainly didn’t.) I haven’t yet found the comment I was thinking of, but the retrospective is informative. I’m about 300 comments in, and I’ve seen maybe 4 attempts to substantively add to the conversation, and hundreds of attempts to be rude and obnoxious to pretty much everyone on the site.
While I will certainly cop to being imperfectly polite, seeing a retrospective of you in the comments is actually kind of staggering.
Why don’t you guys e-mail each other or something? Jeez.
Classic example, and one in which I am not at all involved here.
That’s a pretty funny link, Sebastian, given that it involves me and Jesurgislac, which sheds additional light on your earlier comment that I “can’t, and don’t” ever “disagree with someone on [my] side.” Which is to say, you actually did manage to say something else incorrect! Bravo!
What’s more, note the nature of the interaction, which involved her stating that I did not say something that I clearly did. It’s more akin to what happened here, today, with you, than it is anything else!
and I’ve seen maybe 4 attempts to substantively add to the conversation
There are more than that in this thread alone, so I am going to once again going to question your ability to read for comprehension rather than for speed. Please, please do not make me once again go find the thread where you forgot with whom you were arguing, and what about, and thoroughly embarrassed yourself as a result. For both our sakes.
Really, you need to get over your obsession with me. I’d recommend some guys in the Bay Area for you, but they’re all straight.
hsh, I have nothing to say to Sebastian that cannot be said here on the site. I believe he got assy about getting fact-checked and found wrong, decided to take a dump on me as a result, got his hand slapped and now needs to apologize.
I believe he got assy about getting fact-checked and found wrong
This ain’t my fight, but if I was going to guess, I would say it was your 2:20 that pissed him off.
Just a thought.
Further to this debate, a recent Amnesty International report
Pro-lifers may fake a concern for the poor little “babies” being aborted, but their actual concern – demonstrated by the position they take in the health care debate – is squarely against saving lives, even fetal lives, if this would mean providing adequate health care to all.
The AI report notes that black women are “nearly four times as likely as white women to die from pregnancy-related causes” – this is race-related poverty, and institutional racism opposing equal provision of healthcare according to need.
It’s no wonder that the pro-lifers on the blog – Von, Sebastian, Marty, Brett, McKinney – are coming out against universal healthcare. One may speculate what could possibly motivate a bunch of white right-wing men to be so much against equal provision of healthcare to women that would save so many women’s lives – and in particular, save proportionally far more black women’s lives than white women’s lives – but that they do not care about human life, and in particular about women’s lives, is part of being a pro-lifer… and part of why they object so strenuously to universal health care.
It is a horrid irony that these people call themselves āpro-lifeā.